Booklet

ELDER ABUSE CONTEXT AND THEORY
Finland, Ireland, Italy and Romania
The S.T.AGE project is funded by Erasmus+

KA2 under Grant Agreement
2015-1-IE01-KA204-008632
www.stageproject.eu
Elder Abuse Context and Theory: Finland, Ireland, Italy and Romania 1
This publication has been produced with the support of the Erasmus+ Programme of the European Union.
The contents of this publication are the sole responsibility of the partnership and can in no way be taken to
reflect the views of the NA and the Commission.
2 Elder Abuse Context and Theory: Finland, Ireland, Italy and Romania
Elder Abuse Context and Theory
Finland, Ireland, Italy and Romania
The S.T.AGE project is funded by Erasmus+

KA2 under Grant Agreement
2015-1-IE01-KA204-008632
www.stageproject.eu
Contents
Contributors p. 7
Preface p. 8
Chapter 1: Background and Context
1.1 Introduction p. 9
1.2 Definition of elder abuse p. 9
1.3 Types of abuse p. 10
1.3.1 Older persons perspective of elder abuse p. 12
1.4 Prevalence of elder abuse p. 12
1.4.1 Prevalence in general older population p. 12
1.4.2 Prevalence in vulnerable older population p. 13
1.4.3 Prevalence of abuse perpetrated by family (informal) carers p. 14
1.4.4 Prevalence of abuse perpetrated by professionals in care settings p. 14
1.5 Abuse reported to the authorities p. 16
1.6 Conclusion p. 17
Chapter 2: Theoretical Perspective

2.1 Theories that inform understanding of elder abuse p. 19
2.1.1 Theories related to interpersonal relationships p. 19
2.1.2 Theories related to societal and a multisystem context p. 20
2.2 Risk factors associated with elder abuse p. 21
2.2.1 Risk factors and the individual p. 21
2.2.2 Risk factors and vulnerability p. 23
2.2.3 Risk factors and caring p. 23
2.2.4 Risk factors related to professionals and institutional environment p. 24
2.3 Theories informing interventions p. 25
2.3.1 Interventions based on empowerment p. 25
2.3.2 Interventions based on reducing carer stress p. 26
2.3.3 Interventions based on social ecology model p. 26
2.4 Do existing theories tell the whole story? p. 28
Chapter 3: Generational Intelligence Framework
3.1 Addressing the complexity of interpersonal relationships and the p. 31
social environment
3.2 Generational Intelligence p. 32
3.3 Generational Intelligence and elder abuse p. 33
3.4 Ageism and elder abuse p. 33
3.5 Generational Intelligence in the context of caregiving p. 34
Chapter 4: Sociodrama Approach

4.2 The Performing Arts and Drama Approaches to Training p. 36
4.2.1 Creative drama p. 36
4.2.2 Sociodrama p. 37
4.3 Sociodrama as a vehicle for change p. 38
4.4 Types of Sociodrama Practices p. 39
4.5 Tackling elder abuse and promoting change through Creative p. 40

Drama
4.5.1 Tackling elder abuse - a multifaceted concept p. 40
4.5.2 Applying Sociodrama to training p. 40
Chapter 5: Conclusions
5.2 Addressing elder abuse p. 42
5.3 Addressing elder abuse through a generation intelligence p. 43

framework
References p. 45
Appendix One p. 53
Contributors
Marita OBrien, Age Action (Ireland)
Sam OBrien-Olinger, Age Action (Ireland)
Licia Boccaletti, Anziani e non solo (Italy)
Salvatore Milianta, Anziani e non solo (Italy)
Ioana Caciula, Asociatia HABILITAS Centru de Resurse si Formare Profesionala (Romania)
Henriikka Laurola, Suvanto For a Safe Old Age (Finland)
Sirkka Perttu, Suvanto For a Safe Old Age (Finland)
Anna Kadzik-Bartoszewska, The Gaiety School of Acting (Ireland)
Kate Canning, The Gaiety School of Acting (Ireland)
Seamus Quinn, The Gaiety School of Acting (Ireland)
We wish to acknowledge Justin Moran and Naomi Feely, Age Action, for their helpful
comments on a draft of the book.
PREFACE
This book explores the topic of elder abuse from the perspective of four countries, Finland,
Ireland, Italy and Romania. The book represents one of a number of resources being developed
as part of an Erasmus Plus funded project called Socio-Drama Tackling Ageism, Preventing Abuse
(S.T.Age).The main objective of S.T.Age is to design an education programme that will provide new
learning opportunities in the field of human rights of older people to prevent elder abuse. Five
organisations have come together to develop this project. Age Action (Ireland); Anziani e non solo,
(Italy); Asociatia HABILITAS Centru de Resurse si Formare Profesionala (Romania) and Suvanto
For a Safe Old Age (Finland) are all non-governmental organisations working to improve the lives
of older people; the fifth partner the Gaiety School of Acting, Ireland, a not-for-profit theatre
school, is involved in developing programmes that address social issues through drama.
Elder Abuse, Context and Theory - Finland, Ireland, Italy and Romania, provides an overview
of elder abuse from the perspective of the four countries. It explores theories associated with
elder abuse and how they inform policy and responses within the four countries. The theoretical
background underlying generational intelligence, the approach taken in the project, will be
discussed. The book concludes by outlining the value of sociodrama as a medium for addressing
social issues. The aim of the book is to set the context and inform the development of the Respect
to Prevent Education and Training Handbook.
The Respect to Prevent education and training resource will develop a series of workshops to
inform and engage older people in residential care settings and care staff. For older people, the
aim of the workshop will be to engage them in embracing and activating their human rights,
nurturing their confidence to report their concerns. For care staff the focus of the workshops
will be on building empathy, addressing ageism and promoting self-care. The Respect to Prevent
Handbook will outline the methodology developed and provide step by step guidance on how to
implement the workshops.
1
Chapter Background and Context
and over in the state, accounting for 11.7 per cent

1.1 Introduction of the total population, 25 per cent of these are
aged 80 and over. By 2041, there will be 1.4 million
Abuse of older people is not a new phenomenon, people aged 65 and over, representing 22 per cent
although formal responses are still in their infancy of the population (Central Statistics Office, 2012).
in many countries. The concept of elder abuse In Finland, 19.9 per cent of Finnish population is
was first described in the UK in scientific journals aged 65 and over, and by 2060, 28.8 per cent of
in the 1970s. However, the conceptualisation its population is projected to be over 65 years of
of elder abuse only received wider public and age (Population and Justice Statistics, 2015). Italy
governmental attention towards the end of the 20th is also facing the challenge of population ageing,
century. Addressing elder abuse is now regarded as with 22 per cent of its population aged 65 and over
a universal reflection of worldwide concern about (National Institute of Statistics, 2016). In Romania,
human rights, gender equality, domestic violence the older population in 2014 represents 22.8 per
and population ageing. In recent years there has cent (National Institute of Statistics,2014) and in
been a growing body of literature relating to elder 2060 this figure is projected to rise to 35 per cent
abuse prevalence, risk factors and interventions. A (Europa, 2009). Elder abuse will become an issue
systematic review of studies on the prevalence of for more people with the subsequent increase in
elder abuse and the neglect of dependent older the more vulnerable older old (Soares et al., 2010).
adults in various countries has reported abuse rates
ranging between 3.227.5 per cent in the general
1.2 Definition of elder abuse
population (Cooper et al, 2008). A study looking at
elder abuse in seven countries (Germany; Greece;
Italy; Lithuania; Portugal; Spain; Sweden) found that In the Republic of Ireland and in Finland the
19.4 per cent of those aged between 60-84 years definition of elder abuse is based on that which has
were subjected to psychological abuse, 2.7 per cent been put forward by Action on Elder Abuse in 1993:
to physical abuse, 0.7 per cent to sexual abuse and A single, or repeated act, or lack of appropriate
3.8 per cent to financial abuse (Soares et al, 2010). action, occurring within any relationship where
In Europe, the number of people aged 60 and over there is an expectation of trust which causes
is expected to increase from 161 million in 2010 harm or distress to an older person or violates
to 236 million in 2050. People aged 60 and older their human and civil rights (Protecting our
make up 12.3 per cent of the global population Future, 2002).
now, but by 2050, that number will rise to almost This definition was subsequently adopted by
22 per cent (United Nations Population Fund, the World Health Organisation (2002) and is the
2015). According to the 2011 Census, in Ireland most widely used also in Italy and Romania. It
there are approximately 535,393 people aged 65 covers the frequency and intensity of the abuse;
recognising acts of omission and commission as In Romania, a study by Sorescu (2011) shows
well as intentional and unintentional forms of that, perceptions of abuse amongst professionals
abuse. There is a relationship between the abuser working in social services is broader than the
and the abused where there is some expectation of generally accepted definition of elder abuse. Some
trust. Self-neglect and abuse by strangers including actions such as violence, ignoring health problems
scams targeting older people because of perceived and theft are in line with other definitions and
vulnerability are not universally accepted as elder understandings of elder abuse. However, other
abuse. actions such as environments being unsuitable
to a persons disability, inadequate pensions and
However in some countries, for example in Italy,
exploitation, while also often bi-products of ageism,
it is argued that in determining elder abuse, a
do not constitute traditional understandings of
relationship is not always necessary. Some of the
elder abuse. However Biggs and Lowenstein
most recognised forms of elder abuse are theft and
(2011) highlight the concern that where definitions
fraud targeting older persons and opportunistic
are too broad and include self-neglect or abuse
crimes such as bag-snatching at post-offices on
and exploitation by strangers, elder abuse loses
pension days. In these situations, a relationship
meaning.
does not exist, or fraudsters may gain the older
persons trust without any previous relationship. In To overcome these challenges, an expanded
Finland, crimes targeting older vulnerable people conceptual framework that includes three
are perceived by the authorities as part of the dimensions has been proposed (Brownell and Powell,
larger phenomenon of elder abuse. In Ireland also, 2013). Within this framework crimes by strangers
the integration of the National Elder Abuse policy against older people is one dimension, self-neglect
within a wider Vulnerable Adult Safeguarding policy is a second dimension and elder mistreatment the
places greater emphasis on taking advantage of a third dimension. Elder mistreatment includes the
person due to their vulnerability. established understanding of abuse perpetrated by
trusted others in the home or in dependent care
A point for debate is the necessity that an act
institutions.
occurs within any relationship where there
is an expectation of trust. In an abusive care
relationship, an expectation of trust may no longer 1.3 Types of abuse
exist where the person is experiencing on-going
abuse. However this may not mean the relationship In Ireland, Finland, Italy and Romania the types of
is over, as the older person may be dependent on abuse recognised correlate with those defined by
the perpetrator for their care. World Health Organization WHO (2002) and include:
Goergen and Beaulieu (2010, 2013) argue that physical abuse: the infliction of pain or injury,
confining the phenomena of elder abuse solely to physical coercion, physical/chemical restraint.
relationships and narrow notions of vulnerability Physical abuse may include hitting, slapping,
does not take account of attempted victimisation of pushing, kicking, spitting, misuse of medication,
an older person. The criminal law systems recognise restraint or inappropriate sanctions;
the distinction between attempted offences and
completed offences. psychological abuse including emotional
abuse, verbal abuse, deprivation of contact, and occur frequently. These types of abuses can
humiliation, blaming, controlling, intimidation, be more objectively measured than for example
coercion, harassment, isolation or withdrawal psychological abuses, and are relatively more
from services or supportive networks; easy to prove. The need for a police report to
activate special insurance policies that some local
financial/material abuse: the illegal or
governments (such as the Municipality of Rome)
improper exploitation and/or use of funds or
provide for older victims of crime is another reason
resources. This can include theft, coercion,
for their increased visibility. Considering the paucity
fraud, exploitation, pressure in connection
of published studies in Italy about elder abuse there
with wills, property or inheritance or financial
are some authors (among them the Criminologist
transactions, misuse of power of attorney or
Isabella Merzagora Betsos) who consider emotional
the misuse or misappropriation or property,
abuse the most widespread even if the least visible.
possessions or benefits;
The literature also identifies legal maltreatment,
sexual abuse: non-consensual sexual contact whereby an older person is deprived of his civil
of any kind with an older person; rights or declared legally incapable beyond the
real extent of their mental and physical conditions.
neglect/abandonment: intentional or Physical abuse, even if less frequently reported and
unintentional refusal or failure to fulfill a care- punished, garners greater media attention and this
taking obligation. This can include ignoring facilitates social recognition. However, it can be very
medical or physical care needs, failure to difficult to officially investigate, prove and punish in
provide access to appropriate health, social situations of physical abuse.
care or educational services, the withholding
of the necessities of life, such as medication, In Romania, the most recognised forms of elder
adequate nutrition and heating, and failure to abuse are physical abuse and financial abuse.
provide appropriate equipment. Physical abuse is recognised because it is subject
to legislation under prevention and combating
Other types of abuse are addressed within national of violence by family members. Financial abuse
policy documents, legislation and EU research. is more likely to be detected and reported, as
For example, Irish elder abuse policy recognises frauds are subject to public awareness campaigns
discriminatory abuse, defined as racism, ageism, organised by the national police force. All other
and other forms of harassment, slurs or similar forms of abuse are still not recognised or tackled, as
treatment and institutional abuse defined as poor elder abuse is a taboo subject and professionals, as
standards of care, rigid routines and inadequate well as the general population, are not fully aware
responses to older peoples complex needs within of what constitutes elder abuse. A study (Caciula
care settings. In Italy discrimination and institutional et al., 2010) found that most home care workers
abuse categories are rarely present in legal literature were unable to correctly identify abuse and were
or public debate. half as likely to identify the restriction of liberty and
In Italy, the most recognised type of abuse and also neglect correctly as abuse. This is in comparison to
the object of penal rules is financial abuse. This similar English and Australian surveys that asked
probably relates to the fact that criminal offences professionals the same questions (Selwood et al.,
against property are reportable to the authorities 2007; Hempton et al., 2011). This is probably due to
the fact that elder abuse prevention does not form Psychological, emotional and verbal abuse;
part of staff training in Romania. Another study from
Romania shows that social services professionals Physical abuse;
identified another form of elder abuse - social
abuse seen as isolation, neglect and exploitation Legal and financial abuse.
(Sorescu, 2011).
1.4 Prevalence of elder abuse
1.3.1 Older persons perspective of elder
abuse
Prevalence of elder abuse varies from one country
For research, training and practice development
to another, with figures ranging from 2.2 per cent
purposes it is important to understand how older
in Ireland to 13.4 per cent in Italy. In the following
persons themselves perceive and define elder
section, we will examine more closely the statistics
abuse. Older persons own views of elder abuse
regarding the prevalence of elder abuse in Ireland,
were investigated as a part of an international
Finland, Italy and Romania. The focus will not only
multicultural research project (Perttu, 1998). The
be on the general older population, but also on
participants of the study were older persons aged 60
vulnerable older persons, abuse perpetrated by
years and over. At least 50 people were interviewed
family carers, by professional workers, and finally
in each participating country (including several
abuse reported to the authorities.
minority groups in USA, Norway, Japan and Finland).
In Finland the recipients named all forms of abuse:
1.4.1 Prevalence in general older
physical, psychological, financial and sexual abuse
population
as well as neglect. They also recognised social
It is hard to estimate how prevalent elder abuse is
mistreatment as a form of abuse, meaning e.g.
in our society. In countries with a well-developed
violation (i.e. denial) of their personal rights.
national elder abuse policy, such as Ireland, data is
A similar study was conducted in Ireland. Older collected. The National Centre for the Protection
people living in the community participated in eight of Older People carried out the first elder abuse
focus groups. The participants saw elder abuse as prevalence study in the Republic of Ireland in 2010.
a diminishment or withdrawal of personhood, that This study reported a prevalence rate of 2.2 per cent
is the transition of the older person from person to of people aged 65 and over living in the community
non-person (OBrien et al., 2011). In another project who had experienced abuse in the previous 12
exploring the older persons own views of elder months. Financial abuse (1.3 per cent) was the
abuse in Argentina, Brazil, India, Kenya, Lebanon, most frequent type of abuse reported, followed by
Canada, Austria and Sweden (WHO/INPEA, 2002), psychological abuse (1.2 per cent), physical abuse
participants identified the following key categories (0.5 per cent) and neglect (0.3 per cent). The least
of abuse: common type of abuse reported was sexual abuse
(0.05 per cent) (Naughton et al., 2010).
Structural and societal abuse;
And Finland, figures vary depending on the studies
Neglect and abandonment; reviewed. Kivel et al. (1992) reported that between
the age of 60 and 75, 9 per cent of women and 3 per
Disrespect and ageist attitudes;
cent of men experienced abuse, rising to 8.3 per psychological and financial abuse men reported
cent for women and 7.7 per cent for men in those higher figures than women and vice versa for physical
over 75 years of age in two municipalities in Finland and sexual abuse. Types of abuse reported in order
(Virjo&Kivel, 1994). The AVOW research project of prevalence were: financial abuse, physical abuse
found that 25 per cent of Finnish women over the and sexual abuse (Di Rosa et al., 2015).
age of 60 living at home had experienced violence
Crime figures also give some indication of abuse
or abuse during the past 12 months (Luoma et al.,
against older people in Italy. In 2014 crimes against
2011). Emotional/psychological abuse was the most
people aged 65 and over increased by 4.4 per cent
common form of abuse experienced by 21.2 per
while crimes reported by people under 65 years fell
cent of older women, followed by financial abuse
by 4 per cent (Confartigianato, Ufficio Studi, 2015).
(6.5 per cent), violation of rights (5.7 per cent) and
This is only an indicator for incidence of financial
sexual abuse (4.6 per cent). Physical abuse (2.8 per
abuse including theft and scams.
cent) and neglect (2.6 per cent) were the forms of
abuse reported least by women. Romania lacks data regarding the prevalence of
elder abuse. However, the Special Eurobarometer
Population based surveys in Finland and in the
Survey 283 Health and Long term care in the
Nordic countries show that between 4 per cent and
European Union found that Romania is the only
6 per cent of older people experience some form of
country in the EU where the majority of population
abuse in home settings and that abuse and neglect
(86 per cent) considers that poor treatment,
in institutions may be more extensive than generally
neglect and abuse of older people is widespread
believed (Luoma, Koivusilta et al., 2010). In Sweden,
at national level. Romania also ranks the highest in
a study showed that 16 per cent of women and
terms of the perceived risk of older people being
13 per cent of men had experienced violence or
maltreated generally; 84 per cent of the Romanian
neglect after the age of 65 (Eriksson, 2001).
population believe that older people are living in
In Italy, prevalence of elder abuse, in general, can poor conditions, 86 per cent consider that older
only be estimated from comparative research people lack attention to their physical needs, 84 per
carried out at an EU level. For example, the ABUEL cent consider that older persons receive inadequate
Project, Abuse and Health among elderly in Europe, care, 76 per cent think that older persons are
2012, using a sample of people between 60-84 psychologically abused and 71 per cent think that
years old in Italy, found that 13.4 per cent of those they are physically abused.
surveyed reported abuse -excluding abandonment
and negligence (Di Rosa, 2015). This sample did 1.4.2 Prevalence in vulnerable older
not include more vulnerable older people or those population
living in residential and other care setting. Men Older people with significant physical and cognitive
reported higher figures than women (60.7 per cent, impairment who are dependent on others for care
male; 39.3 per cent, female). People in the 70-74 were identified as being particularly vulnerable
age group reported the highest incidences of abuse. to elder abuse. In Ireland and Italy, this finding
(Di Rosa et al., 2015). is confirmed by research, while in Finland and
Romania data is as yet not available.
The most common form of abuse reported
was psychological abuse (19.4 per cent). For In Ireland, Naughton et als (2010) study found that
older people with poor physical health were over significant: the victims home was found to be the
three times more likely to report mistreatment, setting for psychological abuse in 37.4 per cent of
while those with below average mental health cases and in 41.2 per cent of financial abuse cases.
scores were nearly six times more likely to report
Similar to the situation in Ireland, the Special
mistreatment. Studies from Ireland and the UK show
Eurobarometer 283 Health and Long term care in
that half of carers and family carers of persons with
the European Union states that in Romania, the
dementia or other psychological disorders admit
perceived offenders in elder abuse are mostly the
having carried out some form of abusive behaviour
children of an elderly person (25 per cent), followed
(Cooney et al, 2006; Cooper et al., 2009). Verbal
by care workers/home help/nurses working in the
abuse was the most commonly reported. The 2014
persons own home (22 per cent) and staff in a care
Health Service Executive (HSE) Elder Abuse report
home (22 per cent).
found that in 64 per cent of confirmed cases of
abuse, older persons had health issues. Finland has no relevant data on this subject, but
in a population-based Swedish study (Grafstrm,
In Italy, studies also indicate that older people
1993), 12 per cent of family members of cognitively
with poor health are 2.5 per cent more likely to
impaired older people reported abusive behaviour
be victimised than others. This study also shows
in care.
that older people with lower quality of life are
approximately 3 per cent more likely to be victims
of abuse than others. (Di Rosa et al., 2015)
1.4.4 Prevalence of abuse perpetrated
by professionals in care settings
The vast majority of older people resident in
1.4.3 Prevalence of abuse perpetrated
nursing homes are cared for in safe and supportive
by family (informal) carers
settings. However, in many countries, media
In Ireland, research undertaken by Naughton et al
and other reports highlight incidences of abuse
(2010) found the main perpetrators of elder abuse
within care settings. Over the last two decades in
were adult children (50 per cent of cases), followed
Ireland, reports and media reporting highlighted
by spouse/partners and other relatives. The Health
instances where older people were mistreated in
Service Executives Elder Abuse report (2014)
residential settings. Reports include Abuse, Neglect
reported a similar figure, with 49 per cent of adult
and Mistreatment of Older people: An Exploratory
children responsible for abuse reported. In Italy, the
Study, Protecting Our Future: Report of the Working
situation differs.
Group on Elder Abuse, and the Commission of
According to ABUEL findings (Di Rosa et al., 2015), Investigation into Leas Cross Nursing Home.
the main perpetrator of psychological abuse is the
In determining prevalence rates for abuse within
spouse or the partner (20.3 per cent), followed by
residential care settings, the results of surveys of
other relatives (14.5 per cent) and, finally, children/
nursing staff and/or family gives some indication
nephews (13.4 per cent). As to financial abuse, within
of the prevalence of neglect and mistreatment in
the family, other relatives, meaning members of
nursing homes. In Finland, studies carried out by
the family different from spouses/partner, children
Isola et al. (1997, 2003), found that elder abuse
and nephew, were perpetrators in 5.9 per cent
was rarely reported. Data was gathered from
of cases. Related to this data, the setting is also
nursing staff and the family members of residents.
The most common form of abuse was neglect/ reported that they had been involved in at least one
acts of omission (2003). Around 13 per cent of neglectful act including ignoring a resident when
respondents had witnessed on a weekly basis an they called or requested to be brought to the toilet
older person being left alone unnecessarily and 12 and not changing a resident who is incontinent. A
per cent noticed that older people had been kept very small minority (1 per cent) admitted to over
too long in wet diapers. Episodes of psychological medicating a resident to keep them quiet.
and physical abuse were also observed on a weekly
The level of self-reported mistreatment was lower,
basis and included forms of degrading speech as
with 7.5 per cent of respondents acknowledging
well as in heavy-handed caregiving. However,
they had perpetrated psychological abuse, 3.6 per
it is estimated that elder abuse perpetrated by
cent of respondents reporting they had committed
healthcare professionals in care settings is an every-
one or more acts of physical abuse, 0.2 per cent
day phenomenon in Finland. It is, however, invisible
admitting to financial abuse, theft of residents
due to fear. Elderly people are afraid of reporting to
processions, and 0.2 per cent self-reported talking
avoid being subjected to more abuse (Uuttu-Riski,
or touching residents in a sexually inappropriate
2004; Laakso, 2015).
way.
Research carried out by Drennan et al. in 2012, also
The findings of this Irish study reflect those found in
gives some indication of the prevalence of neglect
research carried out in other countries. A seminal
and mistreatment in residential care settings in
study undertaken by Pillemer and Moore in 1989
Ireland. Like that of the Finnish study, it found that
measured the abuse and mistreatment of older
approximately 57 per cent of staff in residential care
people in the nursing home sector in the US in the
settings reported they had observed one or more
late 80s. The most prevalent form of abuse observed
neglectful acts and 27 per cent reported they had
by staff working in nursing homes was psychological
been involved in at least one neglectful act within
abuse, with 80 per cent of staff reporting they had
the preceding year. The most frequent neglectful
observed at least one incident of psychological
behaviour observed was of staff ignoring a resident
abuse in the previous 12 month.
when they called (52 per cent) and staff not bringing
a resident to the toilet when they asked (40.4 per An issue identified in many studies on elder abuse
cent). The most common form of abuse observed within residential care settings is the inappropriate
by 26.9 per cent of respondents was psychological, use of restraints, including mechanical and chemical.
which included staff members shouting, and This is a consistent finding in relation to measures of
swearing at residents or otherwise insulting them. physical abuse in studies. In Ireland the Department
Physical abuse was observed by 11.7 per cent of of Health (2012) has published a policy on the use
respondents. Financial and sexual abuse were the of restraints, Towards a Restraint Free Environment
least observed forms of abuse with 1.2 per cent in Nursing Homes. The use of restraints is seen
of respondents reporting that they had observed as an imposition on a persons rights and dignity.
financial abuse and 0.7 per cent of respondents Hence restraints should only be used in very rare
reporting that they had observed sexual abuse. exceptional circumstances.
This survey also asked respondents about their
In Romania a study showed that only 6 per cent of
involvement in neglectful act or the mistreatment
the home care workers interviewed had knowingly
of a resident. A total of 27.4 per cent of staff
encountered a case of abuse in the past year (Caciula symptoms but in 17 per cent with behavioural
et al., 2010). This is lower than the prevalence symptoms. Moreover, in 2013 the Ministry of
found in a recent meta-analysis, in which a third Health created a joint task force with the police
of healthcare professionals had detected a case corps responsible for crimes against public health
of older adult abuse in the past year (Cooper et safety (NAS) in order to strengthen the inspections
al., 2009). The observed differences may be due in residential care facilities. In 12 months, over
to lack of training for professionals in elder abuse 1,000 inspections were carried out as a result 174
recognition and prevention; hence they do not penal crimes have been identified.
recognise signs of abuse even when it occurs.
In Finland the National Institute for Health and 1.5 Abuse reported to the
Welfare, THL, collects information on the assessed authorities
health and social care needs of clients in certain
services, e.g. in nursing homes and home care. This Reporting elder abuse to the authorities can be a
data is stored on a database. Information is collected challenge for an older person, therefore generally
using a multi-disciplinary resident assessment tool, speaking there is an issue of under-reporting across
the interRAI Assessment Instrument1, which includes Europe. However, rates and procedures to report
indicators for neglect and abuse. Five indicators are abuse vary across the countries involved in this
used to measure neglect and abuse. These include: report.
the client is afraid of a family member or a carer;
the client is exceptionally untidy; the client has In 2014, the HSE Elder Abuse Service received
inexplicable injuries, fractures or burns; the client 1,961 referrals of alleged cases of elder abuse in
is being neglected, battered or abused; motion of Ireland. Of these, psychological abuse was the most
the client is prevented by any reason. In Finland, frequently reported form of abuse at 29 per cent,
26 per cent of the home care services are using the followed by financial abuse (21 per cent), neglect
interRAI assessment method.2 Approximately 6 per (15 per cent) and physical abuse (12 per cent). Of
cent of homecare clients meet at least one of the referrals received, 26 per cent came from the older
five indicators. However, the reliability of this result person themselves, with the remainder of older
depends on the perceptions of the professionals. people more likely to tell health care professionals,
reflecting referral sources: Public Health Nurse (21
A study by Silvernet research group (2007) on per cent), hospital (15 per cent), HSE community
recipients of home care services in Italy which staff (9 per cent) and GP (7 per cent). The vast
included responses from 4,600 people aged 65 and majority of cases involved older people residing
over, evaluated the prevalence of potential elder in their own home (83 per cent), followed by
abuse. The study also looked at the association residing in a nursing home (7 per cent), 4 per cent
between behavioural symptoms and potential in a relatives home and 4 per cent residing in public
abuse. Signs of potential abuse were identified continuing care units. The majority of referrals
in 9 per cent of participants without behavioural related to older females with most cases alleging
1
www.interrai.org just one type of abuse. Where cases involved more
2
National Institute for Health and Welfare THL. A multi-disciplinary than one type of abuse the second form was most
quality tool Resident Assessment Instrument RAI, www.interrai.org.,
https://www.thl.fi/fi/web/ikaantyminen/palvelujen-ja-hoidon-laatu/rai- likely to be psychological abuse (HSE, 2015)
vertailukehittaminen
In 2014, the Health Information and Quality a national elder abuse policy. The ABUEL study,
Authority (HIQA) received 357 notifications which focused on two of the most frequently
regarding alleged, suspected or confirmed cases of reported abuses: psychological and financial abuse,
abuse of a resident across 182 designated centres. found that in Italy, only two out of seven cases
In addition HIQA received 609 items of unsolicited of psychological abuse had been reported to the
information on 303 designated centres for older authorities, whereas in cases of financial abuse,
people, the majority, 72 per cent, related to quality 10 cases out of 10 had been reported (Di Rosa et
and safety of care. This information was mostly al.,2015). This may indicate a lack of awareness
received from relatives of residents (56 per cent). or even an acceptance of psychological abuse as
Reporting by residents was low at 4 per cent (Health it is more subtle and harder to prove. At the same
Information and Quality Authority, 2015). time, it is hard to explain the high level of reporting
of financial abuse as financial abuse perpetrated
In Finland, compared to Ireland, data on elder abuse
by next of kin (such as spouses, children and
reported to social and health care authorities is not
grandchildren, siblings living together) is not
yet systematically collected, with few incidences
punishable under Italian criminal legislation.
of abuse reported to the authorities. The AVOW
study (Luoma et al., 2010) found that over half of As in Italy, in Romania there are no official statistics
the older women subjected to elder abuse did not regarding the phenomenon of elder abuse. A
report it to anyone. Only two out of three of those report by the National Council for Older Persons in
who reported the events to the authorities felt it Romania, Violence on Older People (2008) looked
helped them. at cases of elder abuse examined by the Forensic
Medicine Institute, Mina Minovici, between 10
A report by the Norwegian Centre for Violence
August 2007 and 15 March 2008. In that time
and Traumatic Stress Studies (Juklestad, 2007)
period 4,540 cases of abuse were examined. Of
notes that only a very small proportion of violence
these cases, 555 people (498 women and 57 men)
against older people is reported to the police. In
reported that they were victims of domestic violence
national victimisation studies, older victims almost
and 9.1 per cent of those experiencing abuse were
never appear.
older people. The same report found that 12 per
Police statistics collected in Finland on family cent (4,918) of victims of crime in 2008 investigated
violence in 2013 indicate that there were 407 by the Romanian police were aged 60 and over,
cases in which the victim was 60 years of age or with 3,994 being subject to physical violence, 254
older. Of these 407 cases, the majority of victims to theft, 138 to rape and 98 to murder.
were women (264). In 300 cases, violence was
perpetrated by a family member living in the same 1.6 Conclusion
household with the victim. In the rest of the cases,
the perpetrator was a family member living outside
This chapter highlighted how understandings and
of the household (SVT, 2013).
definitions of elder abuse differ between the four
In Italy, a national official database on elder abuse is countries reviewed. In short, we clearly saw that
not in place. This may be due to the fact that there what constitutes an incident of elder abuse, and
is neither an official definition of elder abuse nor how societies understand and tackle the problem,
varies internationally. Whichever definition is most ageism and individuals discrimination against older
accepted in each jurisdiction one of the consistent people, should qualify under such criteria.
themes that must be faced up to is how the topic
Regarding the prevalence of abuse, in countries
remains highly taboo across cultures. Another
without a well-developed national elder abuse
difficulty surrounds reporting of elder abuse
policy, data collection, or rather the lack
because many older people may not realise they
thereof, slows progress as in Italy and Romania.
are being subjected to abuse or are afraid of being
Methodological inconsistencies make international
subjected to more abuse (Uuttu-Riski, 2004; Laakso,
comparisons difficult. In Italy and Romania official
2015). As a consequence addressing the issues
statistics regarding the phenomenon of elder abuse
surrounding elder abuse remains complex. Perhaps
are not kept.
the most comprehensive list of what is considered
elder abuse comes from combining every countrys What is clear from Chapter One is that a prevention
definition so that areas such as neglect, physical, and intervention model informed by sound
psychological, financial, sexual, as well as social evidence, established theories and effective
abuse (isolation and exploitation) are all equally national policy is very much needed to adequately
deemed unacceptable. In other words, anything take on all of the associated challenges in order to
that produces the diminishment or withdrawal of protect and empower older people in every country
older peoples personhood, contributing to their from relationships and situations which make them
transition from person to non-person, must be vulnerable to being abused.
taken as a form of abuse. In this light structural
2 Theoretical Perspectives
Chapter
Theories help make sense of a social phenomenon, 2.1.1 Theories related to interpersonal
like elder abuse. Theories can be used to understand
relationships
a social phenomenon, why something happens, but
also to affect change. Theoretical orientation not only
Social Exchange Theory
steers the study of a social issue but, as Ojuri (2004)
argues in relation to the study of domestic and family This theory comes from the field of psychology and
violence, the integration of theoretical approaches economics. The focus of this theory is on the social
into practical interventions. In this chapter, theories exchange of material (e.g. money, living arrangements)
used to inform our understanding of elder abuse and nonmaterial goods (e.g. approval) within a
are explored. The way these theories influence our relationship. Where this balance is upset or perceived
understanding of risk, prevention and intervention to be upset, one party may feel they are not getting a
at a national level will be reviewed. The chapter will fair return and may resort to abuse (Homans, 1958).
conclude with a discussion on the ability of these For example, an adult child providing care to a parent
theories to address the complexity of elder abuse. may feel entitled to keep some of their pension.
2.1 Theories that inform Social Learning Theory
understandings of elder abuse Social learning theory proposes that violent acts are
a learned behaviour. A person has learned, through
Few theories have been developed that specifically the process of modelling, to use violence in an
address elder abuse. The theories used to inform earlier context to either resolve conflicts or obtain a
our understanding of elder abuse have mainly been desired outcome (Bandura, 1978).
adapted from other fields, including child abuse
Caregiver Stress Theory
and intimate partner violence. These theories focus
on interpersonal relationships and societal and a Caregiver stress theory centres on the family
multisystem context. Amongst the theories espoused members caring for an older adult with significant
at the level of interpersonal relationships are social care needs. Without support, the carer may be
exchange theory, social learning theory, and caregiver unable to adequately manage their responsibilities
stress theory. At a societal/ multisystem level, and become overwhelmed and frustrated leading
theories centre around power and control theory, a to abuse (Anetzberger, 2000). In many instances,
feminist approach, positional theory and an ecology the person caring may not have the knowledge to
social framework. manage a particular situation, or may be unaware
that their behaviour is considered abusive. This
theory originates from theories on child abuse and
the dependency of the victim as a source of stress
for the carer, under the assumption that since elder
abuse, child abuse and other forms of intra-family Malignant positioning like this, can contribute to
violence share some obvious similarities, they can the creation of a climate that allows elder abuse
all be explained by the same theories. to take place or a social environment that fails to
prevent it (Stevens et al., 2013).
2.1.2 Theories related to societal and a Social Ecology Theory

multisystem context
Power and Control Theory, a feminist approach Social ecology theory looks at the interactions
A feminist approach assumes that gender defines between the individual, relationships, community
womens role and status in society and shapes their and society and how these influence well-being
social relationships (Nerenberg, 2014). While there (Schiamberg et al., 2000). This framework has
are plenty of feminist theories of domestic violence, been increasingly employed to understand
conceptualisations highlight mens power and the complexities of elder abuse, from multiple
control over women (Brandl, 2002; DeKeseredy and perspectives, on a range of levels and in a diversity
Schwartz, 2011). According to the approach, mens of settings (Bronfenbrenner, 1979, Norris et al.;
violence against women should not be seen as Wango et al. 2014).
arbitrary and irrational acts or simply in the context
of families and interpersonal relationships but The ecological systems theory, as outlined by
within its social and cultural context (Dobash and Bronfenbrenner (1979), identifies the influence of
Dobash, 1979; Penhale, 2003; Ojuri, 2004). Among different environmental systems on the individual.
those practices that men use to keep women in
their subordinate position, violence and abuse are The focus is on the interaction at four levels
the most effective forms of control (ibid). micro-system the relationship between
the older person and individuals within their
Positioning Theory immediate settings such as their home or
nursing home, family and social networks;
Positioning theory provides for the linking between meso-system the relationships between the
micro-interaction (interpersonal explanations for micro-settings that include the older person,
abuse), institutional (organisational characteristics) such as institutions that provide services;
and macro-element (e.g. ageism) (Van Langenhove exo-system the social structures and systems
and Harr, 1999; Stevens et al., 2013). The focus that do not directly contain the older person,
but which impact upon the immediate micro-
of the theory is on the connections between social
system in which the older person is situated
interaction, individual understanding and actions, and can include health policy, social welfare
the interaction between the older person and the system, adult protection services;
trusted other set within the context of factors macro-system centres on the overarching
that include status, rights and duties. For example, beliefs and dominant social values around
a persons dignity is either enhanced or diminished ageing, such as ageist attitudes towards older
people.
depending on how they are positioned. If the
person is seen as incapable of making decisions, the
person may be seen as less worthy of interaction.
aged greater than 80;
2.2 Risk factors associated
with elder abuse gender (being female);
Whilst theories inform understanding, OLoughlin low income, poor health;

and Duggan (1998) argue that there needs to be a cognitive impairment;
distinction made between theories and risk factors.
mobility difficulties;
Specific risk factors are part of a wider theory,
rather than theoretical explanations. Determining depressive symptoms; and
risk is therefore influenced by public understanding
poor social network. (Dong et al., 2014)
and institutional responses within countries.
Older people with three to four risk factors were
2.2.1 Risk factors and the individual almost four times more likely to experience elder
Research has identified risk factors that make older abuse, and those with five or more risk factors
people more vulnerable to elder abuse. These risk were 26 times more likely (Dong et al., 2014). Table
factors may fall into one of a number of theories. 1 below outlines risk factors acknowledged in the
The following factors contribute to a Vulnerability partner countries.
Risk Index:
Table One: Risk factors associated with elder abuse evident in the four countries
EVIDENCE
IRELAND, FINLAND, ITALY

RISK FACTORS
COUNTRY WHERE FOUND RELEVANT

In Ireland, people aged 80 years and over, reported the highest level of mistreatment (2.5 per cent) followed by the
70-79 years age group (2.4 per cent) (Naughton et al., 2010).
According to the Finnish AVOW study survey results, the oldest age group (79 and older) were at greatest risk of
Older age neglect (3.8 per cent). However, the younger old (ages 60-69) were at higher risk of emotional abuse and violation
of rights, prevalence rate of 32.7 per cent (Luoma et. al., 2010).
In Italy the oldest age group (70-84) was at greater risk than the youngest (60-69): 80.9 per cent the oldest old;
19.1 per cent the youngest old (Di Rosa et al., 2015).
IRELAND, ITALY
In Ireland, 2.4 per cent of women reported mistreatment, mainly financial, compared to 1.9 per cent men
Gender (Naughton et al., 2010). In 2014 66 per cent of referrals to HSE Elder Abuse Service related to women (Health
(being Service Executive, 2015).
female) In Italy, the outcomes are opposite, with 60.7 per cent of men reported abuses compared to 39.3 per cent women
(Di Rosa et al., 2015).
IRELAND, FINLAND,
In Ireland, people living on less than 220 per week, the minimum State Pension for a single person in 2010,
reported the highest level of mistreatment, followed by those living on between 220-438 per week, with 438
ROMANIA
the minimum State Pension for a married couple (Naughton et al., 2010).
Low income In Finland, a significant association was found between low income and violence and abuse, particularly with
regard to neglect and emotional abuse. In general, financial deprivation places women at higher risk of all types of
abuse (Luoma et. al., 2010).
In Romania, poverty was a risk factor for elder abuse (National Council for Older Persons, 2008).
In Ireland, people perceived to have poor or very poor general health, or physical and mental health scores below
the population average, were three to six times more likely to report mistreatment (Naughton et al., 2010) In
IRELAND, FINLAND,
ROMANIA, ITALY
Finland, the prevalence of neglect was 14 per cent higher for those who reported poor health. Financial abuse,
along with other types of abuse, was also more prevalent in this group. A significant link was found between
self-reported poor health and neglect, only 0.7 per cent of those with self-reported good health had experienced
Poor health
neglect (Luoma et. al., 2010).
In Romania, health status was a risk factor for abuse (National Council for Older Persons, 2008). Older people were
unable to access the medical resources they needed.
In Italy, studies also indicate that older people with poor health are 2.5 per cent more likely to be victimised than
others (Di Rosa et al., 2015).
IRELAND, FINLAND, ITALY IRELAND, FINLAND, ITALY
In Ireland, 33 per cent of clients reporting abuse had dementia (Health Service Executive, 2015).
In Finland, mental and physical ailments as well as dependency for care make older people more vulnerable for
abuse (Mki-Petj-Leinonen, 2003). Older people with memory disorders who require a lot of help are at a higher
Cognitive risk of being subjected to elder abuse than other patients/residents in institutional and residential care settings
impairment (Sipilinen, 2008).
In Italy, the Silvernet Study on recipients of home care services identified signs of potential abuse in 17 per cent
of those with behavioural symptoms and only 9 per cent of cases where the care recipient did not have behavioral
symptoms (Ogioni et al., 2007).
In Ireland, people who perceived themselves as having moderate or poor family support and/or poor levels of
community support were found to be three to four times more likely to report mistreatment compared to those
Social with strong family support and/or medium to strong community support (Naughton et al., 2010).
network, In Finland, the more isolated the older person is, the higher the risk of abuse. Social inactivity was associated with
social abuse, particularly neglect, with 20 per cent of those who took part in no activities subject to neglect, compared to
isolation 3.8 per cent of those who took part even in one or two activities (Luoma et al. 2010).
In Italy, the lack of a social network was found to result in an increased risk for psychological, economical and
physical abuse (Soares, 2012).
2.2.2 Risk factors and vulnerability codependency, dysfunctional family relationships,
financial problems in the family and family history
Risk factors associated with the vulnerability of
of violence. These risk factors can be integrated into
the older person can be integrated into a number
theories relating to social exchange, social learning
of theories including social exchange, social
and social ecology theory.
learning, feminist and positioning theory. Older
age is associated with health and cognitive decline, In a study carried out by Lafferty et al (2014) in
resulting in dependency on others for Activities Ireland, a third of carers reported engaging in
of Daily Living (ADLs), reduced social network, potentially harmful behaviours towards the person
increased isolation. This experience is more likely they were caring for in the previous 3 months.
to affect women as they live longer than men. The Verbal abuse was the most common form of abuse
balance between those providing support and reported. A minority of carers (36 per cent) engaged
those receiving is more likely to be upset within in potentially harmful psychological behaviour.
this context, fitting within the social exchange Factors identified as associated with potentially
theory. Increased requirement for family support harmful psychological behaviour were: living with
opens up the opportunity for learned behaviour the care recipient, carers aged 65 or over, being
as proposed by the social learning theory to come male, higher levels of depressive symptoms, poor/
into play. In a society where women are viewed as fair self-rated health, ethnic/cultural background
subordinate to men, without power and control, (non-Irish), social class (professional/managerial),
this fits within a feminist theory. Risk factors around living in an urban area, providing high level of care.
the vulnerability of the individual are also relevant
to positioning theory, as those older and vulnerable In another Irish study, Downes et al (2013), provide
are designated a malignant position within long- evidence of a higher prevalence of mental and
term care settings. emotional problems among caregivers who abuse.
The most significant factors contributing to the risk
of elder abuse are stress and the burden associated
2.2.3 Risk factors and caring
with caregiving in dementia. This burden is related
Risk factors associated with elder abuse and family
to where a person with dementia exhibits disruptive
caregiving include carer stress, burn out, lack of
or aggressive behaviour. The literature also points to
support, knowledge and adequate training on how
pre-existing intra-familial conflict or abuse and poor
to deal with challenging behaviours (World Health
interpersonal relationships between care recipient
Organization, 2002; Nerenberg, 2002; Ananias and
and caregiver.
Strydom, 2014). The caregiver stress model has long
been the predominant theory used to understand In Italy and Finland, higher carer burden levels,
the underlying dynamics of elder abuse within a particularly in relation to and burden associated
carer/cared for relationship. This is supplemented with caregiving in dementia were common factors
by other theories, such as social exchange, social in relation to risk of elder abuse. Family dysfunction
learning, social ecology theory and positioning was also relevant to all countries
theory.
Whilst these studies link risk factors to theories
There are also risk factors associated with around caregiver stress model, other theories
family system or relationship. These include also fit with the risk factors outlined. For example
social learning and social exchange theories focus for eldercare can also place older people at risk of
on learned behaviour and the imbalance that abuse and neglect (Sipilinen, 2008). At a societal
may occur in caregiving relationships; the feminist level the lack of clear policies regarding elder abuse
model, social ecology model and positioning in some countries puts older people at risk (Uuttu-
theory highlight the role societal structures and the Riski, 2002). These factors reflect inextricable
multisystem play in relation to elder abuse. links between micro-interaction (interpersonal
explanations for abuse), institutional (organisational
Findings from the EURO.P.E.A.N.3 study and from
characteristics) and macro-element (e.g. ageism) as
the ABUEL4 project, highlight that where a person
proposed by positioning theory and that of social
experiences abuse, they are more at risk of future
ecology theory.
abuse. Soares et al (2012) argue that this is due to
the fact that the person experiencing the abuse will Risk factors associated with professional practices
have been left more vulnerable as a consequence and institutional environments can be incorporated
of abuse. into theories such as carer stress theory, positioning
theory and even the social ecology theory. A study
2.2.4 Risk factors related to carried out in Ireland by Drennan et al. (2012) found
professionals and institutional that the strongest predictors of neglect and abuse
environment of older people in residential care settings was
Gilleard (1994) identified three distinctive categories high levels of staff burnout. A number of factors
of abuse in institutional settings. These are abusive significantly related to reported physical abuse and
behaviours (e.g. hitting, pulling), abusive practices psychological abuse of residents included smaller
(e.g. force-feeding, restraint, over-medication) and size residential care homes (fewer than 50 beds),
abusive attitudes (e.g. humiliation, lack of privacy). low levels of job satisfaction, burnout and stress
Certain aspects of the organisational culture of an associated with work, mainly working night duty,
institution which can lead to the failure to provide working with older people for between 11 and 20
appropriate care were identified by Langan and years and organisational commitment.
Mean (1996). These include the loss of personal
Similar risk factors were identified in Finland. In
identity and how the older person is no longer
institutional settings, staff-related risk factors
viewed as an individual. Staff, although they may
for elder abuse include: insufficient training and
experience feelings of powerlessness as employees,
education, lack of time, stress and burnout, frequent
hold a position of relative power over the care
staff turnover, task or task-centred working cultures,
recipient. Staff may also experience professional
low staffing ratio, abusive working culture,
isolation and poor working conditions with no
negative attitudes towards older people, low
opportunity to complain.
wages, lack of elder abuse awareness, policy and
Ageist attitudes among professionals impact on the protocols (Sipilinen, 2008). Whilst in Ireland, the
way older people are treated in nursing homes and smaller size of residential care homes was identified
is a risk factor for elder abuse. Cuts to State funding as a risk factor, in Finland larger institutions were a
3
The European Reference Framework Online for the Prevention of Elder
risk factor.
Abuse and Neglect (EURO.P.E.A.N.) - VS / 2009 / 0549 funded by the
European Commission in the Call for proposals VP 2009 014 for Pilot Projects
on Preventing Elder Abuse
Other factors identified in Finland included
4
Abuel Project Abuse and Health among elderly in Europe, 2012 professionals level of knowledge, skills and coping
mechanisms, along with their cultural background.
Older people with memory disorder or psychological
2.3 Theories informing
symptoms needing a lot of assistance were at greater
interventions
risk of abuse. Less educated/trained staff members Theories provide insight into social issues,
are at a greater risk of perpetrating neglect and highlighting linkages, connections and patterns
psychological abuse (Isola et al., 1995). In Italy, lower between the different factors, which inform
levels of education and training, and associated interventions including prevention strategies. Many
socio-economic factors, were also identified as an of the theories discussed incorporate the absence
element in elder abuse among care staff working in and abuse of power. Hence many interventions are
institutional settings (DAgostino, 2006). Risk factors based on empowerment. The other predominant
identified include burnout of care professionals, theory that informs intervention is the carer stress
challenging behaviour by care recipients, excessive theory.
standardisation of care protocols, the absence
of elder abuse training and a lack of protocols in 2.3.1 Interventions based on
addressing elder abuse. Pigatto (2007), quoting empowerment
Caretta (2001), found that most often elder abuse Empowerment models prioritise the individuals
in residential care settings happens when the ratio agency as paramount. Positive health and well-
of nurses to patients is insufficient and when the being outcomes regarding managing elder abuse
organisation is predominantly oriented to custody stem from older people having increased control
(and therefore patients are seen as passive subjects). over the intervention and that is vital to placing
These risk factors reflect wider organisational power over decision-making in older peoples own
and societal issues explained by theories relating hands.
to positioning theory and social ecology theory
For example in Ireland, the service response to
relating to organisational practices and wider issues
alleged incidence of elder abuse is situated within
like employment and care.
the discipline of social work using the Adult
Conflict between residents and staff members was Safeguarding casework service. The goal of case
another issue identified by Drennan et al (2012). A management is generally to maintain the highest
total of 91.8 per cent of the 1,218 respondents had level of independence and autonomy possible
been involved in at least one conflict with residents (Nerenberg, 2008). Case managers act as advocates,
over the preceding year. The most frequent conflict educators and facilitators (Luu and Liang, 2005).
reported was dealing with a resident unwilling to The principles underlying responses to elder abuse
undress, followed by interactions in relation to a in Ireland are:
resident arguing about leaving their home. This empowerment;
type of conflict reflects how older people may be
rights of the individual;
positioned as incapable of making decisions or
having self-determination. self-determination can involve risk;
least restrictive alternative;
protection of the law;
access to judicial process.
An empowerment approach was also taken in include addressing carer stress and burnout are
developing an intervention to prevent financial offered to formal and informal carers. Again, this is
abuse. Older people worked with academics in not explicitly related to abuse prevention but as a
developing an educational booklet and DVD called way of addressing the depersonalisation of the care
Keep Control. The resource provides information recipient, often mentioned as a consequence of
and tools which empower older people to keep burnout and a risk for the care relationship.
control of their finances and prevent financial
abuse5 . 2.3.3 Interventions based on social
ecology model
Empowerment is a central feature of advocacy work
A review by ODonnell et al (2015) identified
regarding elder abuse. Advocacy can provide older
interventions fitting within a social ecology
adults with an opportunity to express their concerns
framework. At the micro-system level, psychological
and experiences and can support and enable people
and social support intervention targeting at risk older
to make their own informed decisions (Kalaga et al.
people, were found to have the strongest evidence
2007).
of efficacy (Mariam et al., 2015). Interventions
A number of advocacy initiatives for older people reviewed included an educational video and
have been established in Ireland in recent years. booklet aimed at educating older people who were
The latest programme, Support and Advocacy victims of crime (Acierno et al., 2004). In Italy and
Service for Older People (SAGE), provides support Ireland, the police have developed leaflets aimed
and advocacy services for older people who may at educating older people on crime prevention6.
experience challenges in their lives due to ageing Awareness raising and educational DVD, Open Your
including in situations of family conflict, where a Eyes to Elder Abuse in your Community, developed
person is between care settings and where there by the Health Service Executive in Ireland, is aimed
are issues about a persons rights . at educating older people and the general public
about elder abuse and how to prevent it7.
2.3.2 Interventions based on reducing
Regarding the meso-system, these interventions
carer stress
impact on the services provided to the older
In Italy, Ireland, Romania and Finland, interventions
person, which in turn impact on the micro-system.
focused on supporting carers have been developed.
Interventions evaluated included:
For example peer support groups aimed at
preventing burnout among carers are widespread a) support groups for older people including
survivor groups for example in Finland Suvantos
in Italy, especially among carers of people with
peer support group;8
Alzheimers disease. Although not explicitly referred
b)interventions targeting perpetrator behaviour;
to as being aimed at elder abuse prevention, these
are underpinned by the goal of reducing carers c) interventions targeting caregivers including:
stress. The assumption is that carer stress can informal carers, nurses and nursing assistants/
aides, medics and physicians. In Ireland, elder
affect not only the well-being of carers, but also the
6
quality of the assistance provided. http://www.poliziadistato.it/articolo/view/22099/
7
http://www.keepcontrol.ie/about_campaign
In Italy also, psycho-educational programmes 8
https://publications.theseus.fi/bitstream/handle/10024/66217/Suvanto-.
pdf?sequence=1
5
http://www.keepcontrol.ie/about_campaign
abuse training is mandatory for carers working issue with defined policies for action. Following the
in institutional settings. publication of Abuse, Neglect and Mistreatment of
Older People in 1998, the Government responded
At the exo-system level, interventions target the
by establishing the Working Group on Elder Abuse
links between the individuals immediate context
which published Protecting Our Future. This was a
and wider policy, i.e. adult protective services, the
seminal policy document setting out a framework
criminal justice system, the social welfare system
for action under a number of recommendations for
which impact upon the immediate everyday lives
addressing elder abuse. A key recommendation was
of older people or their micro-system contexts.
that, a clear policy on Elder Abuse is formulated
Some of the positive outcomes associated with
and implemented at all levels of governance within
interventions at this level include raised awareness
the health, social and protection services in Ireland
of elder abuse and the development of response
(Working Group on Elder Abuse, 2002).
systems to cases of elder abuse through training,
advocacy and information provision. Other Understandings of elder abuse shape responses to
examples are changes in regulation such as the elder abuse, in relation to legislation, policy and
Health Act 2007 in Ireland which established a practices in a country. For example in Italy, elder
new system for the registration and inspection of abuse prevention strategies mainly originate from
residential services for older people. Part 2 of the public alarm over issues, thus activities have a
Act established the Health Information and Quality criminological matrix and a public dimension.
Authority (HIQA), an independent statutory body,
charged with promoting safety and quality in the Taking a human rights approach represents a good
provision of health and personal social services by example of macro-level intervention. The focus
or on behalf of the HSE and private nursing homes, is on the implementation of international and EU
through the setting and implementing of quality human rights instruments to tackle elder abuse and
standards based on best practice. Another example protect and promote the rights of older people.
of legislative change is the introduction of Minimum Whilst there is a growing awareness that older
Quality Standards for homecare services for older people face challenges such as discrimination,
persons and for elderly residential facilities, in poverty and abuse that restrict their human rights,
Romania, by the Government, in 2006. the willingness to provide for a legal instrument to
protect older peoples human rights is absent at
Interventions at the macro-system level are aimed government levels.
at addressing areas such as changing more deeply
rooted discriminatory social values and beliefs, Addressing elder abuse within the context of human
resulting in ageism, which puts older people at risk rights changes the emphasis from the interpersonal
of abuse. In the main, macro-system intervention to macro level obligations. It is argued that existing
encompasses areas of legislative imperatives and human rights mechanisms fail to protect and
public policy. promote the rights of older people. There is a
growing call for a new international convention on
Examples of interventions at the macro-system level the rights of older people9. This is seen as the most
include the introduction of public policy to increase 9
http://www.helpage.org/what-we-do/rights/towards-a-convention-on-the-
awareness and detection. For example in Ireland, rights-of-older-people/
https://www.ageaction.ie/how-we-can-help/campaigning-policy/human-
prior to 2002, elder abuse was not formulated as an rights-and-older-people
effective way to ensure that all people, now and in abuse.
the future, enjoy their human rights in their older
There is a lack of evidence that an older persons
age, including their right to freedom from all forms
need for assistance or that caregiver stress leads
of violence and abuse, from torture, cruel, inhuman
to greater risk for elder mistreatment. Firstly, it is
or degrading treatment.
clear from the literature that a substantial number
of older persons are dependent on relatives for
2.4 Do existing theories tell some degree of care. In Ireland, it is estimated
the whole story? that 89.5% of care provided to community
A review of some of the theories, outlined in this dwelling older adults is provided informally by
study, point to a number of inadequacies. This family members (Care Alliance Ireland, 2015).
concurs with Jackson and Hafemeisters (2013) However, findings about the prevalence of elder
review of existing models ability to provide theory- abuse indicate that only a small minority of older
based explanations for their research findings people are mistreated. Since abuse occurs in only
regarding elder abuse. They found that none of the a small proportion of families, no direct correlation
theories offered a full understanding of elder abuse. can be assumed between the dependence of an
older person and abuse, as sometimes has been
For social learning theory, whilst there is some
done. Additionally, case-comparison studies have
evidence to support the hypothesis that children
generally failed to find either higher rates of elder
who have been mistreated go on to mistreat
dependence or greater caregiver stress in elder
their children, research undertaken by Wolf and
abuse situations. The caregiver stress model also
Pillemer (1989) found no significant differences
fails to acknowledge that some victims of elder
between abused and non-abused older people
abuse are in fact healthy and do not require care,
and their method of punishment used. Burnight
or that in some cases the carer is the victim and the
and Mosqueda (2011) point to Quinn and Tomitas
care recipient is the abuser (Phillips et al, 2000).
observation (1997) that it may be more beneficial
Furthermore, interventions aimed at reducing carer
to focus on grandchildrens experience of their
stress and improving communication may do little
parents caring for grandparents and the type of
to protect the victim if the dynamics of abuse are
behaviour witnessed.
rooted in power and control (Brandl et al. 2007).
Jackson and Hafemeisterl (2013) point to the
Using a gender-based approach is justifiable, at least
limited application of the social exchange theory
in the domestic violence context of elder abuse, in
in explaining the continuation of abuse involving
the sense that most of the abuse older women are
elderly parents and their adult offspring, (the most
subjected to is violence or abuse perpetrated by a
common dyad in elder abuse cases). They argue
husband or a spouse (Penhale, 1999; 2003; Luoma
that an abused parent, for example a mother, may
et al., 2010). However, despite the link to domestic
be supporting an adult child with mental health
violence, elder abuse has traditionally been seen as
issues. According to the social exchange theory, the
a gender neutral phenomenon leading, from the
mother should be dissatisfied with the relationship
feminist perspective, to insufficient responses that
as she is receiving little apparent benefit. However,
focus solely on personal or interpersonal problems
in reality this is rarely the case; the abused parent
(Nerenberg, 2014).
will rarely seek to leave the situation or report the
Hence the feminisation of aging and its consequences explain the phenomenon (Nerenberg, 2014). A call
has not largely been an issue of concern. Neglect, for analyses that would consider the dual forces of
abuse and violence against older women have been sexism and ageism in elder abuse has been strong
overlooked as a focus of research; this is in spite of in the past ten to fifteen years (ibid). Negative
the fact that, as a group, older women experience conceptions and harmful stereotypes of old women
unique and compounded disadvantages. Penhale further contribute to marginalization, isolation
(2013) refers to the fact that older women face and brutality of abuse inflicted on older women
triple jeopardy: to be old is to be marginalised (Penhale, 2003). Ageism and feminism together
(single jeopardy); to be old and abused is to be serve better to explain differences in the power and
marginalised (double jeopardy); to be old and status of women and men as well as ageist attitudes
abused and female is to be marginalised (triple toward older people, factors that might lead to
jeopardy). Penhale suggests that to this should abusive treatment of older people (Crichton et al.,
be added two further forms of jeopardy: for those 1999).
women of colour and for those women who are
ODonnell et al (2015) points to how elder abuse
disabled, whether as a results of abuse and violence
transcends a simplistic interpersonal relationship
or not, both of whom experience marginalisation
between perpetrator and victim. Bronfenbrenners
and exclusion. Thus there are five potential areas
(1979) theoretical framework helps to identify,
of jeopardy, disadvantage, and disempowerment
categorise and evaluate interventions that take
that older women could face in later life (Penhale,
into account the multiple, yet interlinking, levels
2003). Gender discrimination across the lifespan
and approaches to the protection of older people.
therefore has a cumulative effect, and neglect,
While a more holistic and multi-level approach to
abuse and violence across the lifespan results in a
interconnected systems and the experiences of
high lifetime rate of suffering from abuse for older
older people and victims of elder abuse is certainly
women (Brownell, 2014).
to be welcomed, the evaluation of the products
Many explanations have been given for why there of ecological systems framework theory illustrate
have been little systematic attempts to develop a the complexity involved in tackling elder abuse.
feminist analysis of elder abuse. Failure to develop a Although this theoretical approach underpins a
gender-based theory has, for example, been linked wide range of interventions with varying degrees of
to ageist attitudes and the failure of the feminist success, such interventions may only have a positive
movement to take an interest in older women impact on specific ecological levels.
(Whittaker, 1995; Nerenberg, 2014).
What is evident from the discussion is the
However, it has also been pointed out that the complexity associated with elder abuse. It cannot
findings of gender differences in elder abuse are be explained by any one theory, so prevention
often inconclusive, ambiguous or even contradictory involves addressing both interpersonal relationships
(Crichton et al, 1999; Penhale, 2003; Nerenberg, and the wider social environment that allow or
2014). Hence, while gender should be taken into permit certain behaviours to happen. Generational
account to understand and respond to abuse, a intelligence offers a different way of understanding
broader conclusion by various feminist researchers elder abuse that incorporates both interpersonal
is that gender-based analysis alone is not enough to relationships and the wider social environment
(Biggs and Lowenstein, 2011).
2.5 Conclusion
The lack of a guiding theory in the field of elder
abuse has been attributed to a number of factors
including - limited, or in some countries the absence
of, national attention or concern; limited recognition
within legislation and public policy and a lack of
public awareness. Whilst the theories discussed in
this chapter offer some explanation as to why elder
abuse occurs, they do not provide a clear theoretical
formula for the prevention of elder abuse or the
development of interventions that can consistently
cross-cut each and every level to comprehensively
address the abuse of older people within our
society. The concept of generational intelligence as a
theoretical basis for understanding elder abuse will
be outlined in chapter Three.
3
Chapter A Generational Intelligence
Framework
It is evident from the previous chapter that theoretical

understandings of elder abuse and risk factors help
3.1 Addressing the complexity
to develop prevention and intervention strategies.
of interpersonal relationship
Understandings of elder abuse engender several and the social environment
forms of institutional response, depending on the
public conceptualisation of the problem criminal Generational intelligence offers an insight into
justice system, welfare system, medical system etc. elder abuse that incorporates both interpersonal
Hence elder abuse may be perceived as a problem relationships and the wider social environment
existing `in itself`, be it a health and social care issue (Biggs and Lowenstein, 2011). Its value in relation
or a criminal matter, resulting in the formulation of to the development of resources to prevent elder
policies from the different system. For example in abuse lies in how it moves away from the narrow
Ireland, elder abuse is viewed as a health and social theoretical spectrum which has traditionally informed
care issue, hence at a macro level the values that elder abuse prevention policies and intervention
underpin elder abuse prevention and intervention are strategies. Within this traditional approach, there
based on social work principles of client autonomy is a heavy reliance on binary opposition, victim and
and empowerment. In contrast, in Italy, elder abuse perpetrator. The concept of binary opposition relates
is seen as an issue for the criminal justice system, to how we think about things (in terms of opposites)
with the public dimension of elder abuse focused on - one cannot conceive of a perpetrator, if we do not
crime prevention, particularly in relation to financial understand the notion of victim. Binary oppositions
abuse, cognitive capacity and inheritance. It is have long been identified as problematic as the
significant to note that the approaches described in categorisation of opposites is often value-laden,
Chapter 2 assign particular roles to those affected by for example the passive victim, and exclude the
elder abuse for example, categorising individuals influence of structural inequalities.
involved as either the perpetrator or the victim
and so on. The main problem in taking a reductionist approach
to elder abuse is it places elder abuse within the
This chapter will explore elder abuse as a narrow confines of interpersonal relationships and
phenomenon situated within a social environment consequently interventions focus on rescuing and
where prevention and intervention focuses on punishing, which may not be sustainable in light of
complex interpersonal relationships that interplay the growing number of older people. This approach
with broader and deeper societal factors. The ignores the complex relationships that exists between
usefulness of a generational intelligence framework adults such as where both people may be vulnerable
in the prevention of elder abuse will be examined. and when placed in challenging situations, resort
to abuse. For example where an adult child with
addiction issues is living with an older parent, by
default they may become a carer to that parent,
regardless of whether the person has the capacity to and Lowenstein (2011) see this lack of awareness of
provide care for another person. Within the victim/ generational complexity as culminating in treating
perpetrator understanding of elder abuse, there is people from the older generation as not having the
little room for empathetic understandings of these same rights as the rest of society.
situations or acknowledgement of the complexity
Relationships are viewed as an intergenerational
of elder abuse. The role of the state and broader
space. To become generational aware or intelligent,
societal structures in creating an environment
one must become aware of ones personal
where elder abuse is more likely such as ageist
generational identity, building empathy towards
structures, is also absent from a binary oppositions
persons from other generations by understanding
perspective.
their values and needs, and also acting in a way that
takes into account generational differences. Shifting
3.2 Generational Intelligence from conflict to solidarity between generations
requires compromise and the equal recognition of
Generational intelligence acknowledges that priorities, not only within families, but also in care
generational identities exist between socially and settings.
self-defined age groups and as a consequence
There are four steps to take to achieve a high level
similarities and differences as well as conflict
of generational intelligence:
and solidarity can develop between said groups.
Biggs and Lowenstein (2011) posit the concept of 1. An inner process of exploration of ones own
generational intelligence as way of understanding generational identity, understanding how
elder abuse. Generational intelligence is specifically cohort belongingness, family and life-course
position affect generational awareness.
The ability to reflect and act, which draws on
an understanding of ones own and others
2. Making the distinction between
life-course, family and social history, placed
within its social and cultural context (Biggs and different generations and understanding
Lowenstein, 2011: 2) intergenerational relationships this means
that a person will begin to put himself in
There is an assumption that perceptions about
the shoes of someone of a different age and
generations and different age groups are rational
to perceive that needs, desires, emotions
and normal. However, perceptions and attitudes
and objectives may be different from one
towards for example older people vary significantly
generation to another.
between cultures. In many western societies ageing
is associated with negative connotations. In other 3. Adopting a value position regarding
cultures ageing is honored and respect for the generational relations this requires the
older person is central, for example Korea. Hence addition of a moral dimension and to closely
attitudes and ideas about other generations and age examine generational power, how we perceive
groups are shaped by society and culture. Whilst our attitudes to older persons.
mainly unaware of this stance, these perspectives
4. Acting generationally intelligently means
can affect how we treat other generations and age
finding solutions and partnerships that take
groups. For example, older people may be viewed
into consideration multiple perspectives of
as a homogenous group, with the same needs. Biggs
intergenerational relationships. (Biggs et understanding of the older persons priorities, their
Lowenstein, 2011) needs within a value system that treats everyone as
equals and where all have a right to participate in
Generational intelligence in the context of
society.
caregiving strengthens empathy between the
different generations. For example, it supports
families (parents, children, grandchildren etc.) to 3.4 Ageism and elder abuse
find solutions that are sustainable for all concerned
taking into account the generational identities and At a societal level, where the older generations
differences. priorities are less important than those of dominant
age-groups, Biggs and Lowenstein (2011) believe,
3.3 Generational Intelligence there is a lack of empathy, the capacity to bridge
and elder abuse unhealthy social gaps between younger and older
people and this gives rise to ageism. Hence, Biggs
and Philipson (1994) contend that confronting
Low generational intelligence is evident, Biggs
ageism is central to understanding and confronting
and Lowenstein (2011) contend, where the age
elder abuse. Ageism as Butler (1987) outlines can
dominant generation can not see beyond their
be seen as a process of systematic stereotyping of
own priorities or assume everyone has the same
and discrimination against people because they are
priorities; differences are seen as threatening; they
old (1987:22). Ageism results in prejudicial and
are part of a value system that demeans others
stigmatising attitudes and behaviour that belittle,
and there is the perception that compromise is
patronise and exclude people because of their age.
unnecessary. For example a care assistant working
This denies their autonomy and dignity and creates
in a residential care setting responsible for assisting
barriers to exercising their human rights on an equal
residents to wash and dress in the morning, has
basis. Negative attitudes impact on the older person
different priorities than the residents. The care
and they come to see themselves as less worthy
assistant must complete the task within a certain
or value to society and contributes to Stevens et
time frame, whereas the residents may be in
al. (2013) notion of malignant positioning. The
no hurry to get up. In addition, a number of the
consequences for the older person is reduced
residents may have dementia, they may react and
dignity, opening the older person to abuse.
behave differently when roused. This behaviour may
be perceived as threatening to the carer in relation Negative social attitudes towards older adults
to getting work tasks completed or even to their are acknowledged as a permissive element for
personal safety. People with dementia experience elder abuse (Biggs and Lowenstein, 2011). Social
stigma, so are not accorded the same rights as the ageism, therefore acts as a permessor, a factor
rest of society. They may be positioned as not that permits elder abuse to happen as it creates a
having decision-making capacity, hence are often context or social space that makes the behaviour
excluded from decision-making, with the loss of any possible, even more likely. Ageism results in age
negotiating powers. segregation, for example special clubs, groups and
institutional settings like nursing homes are set up
Empathy, being able to put yourself in the older
for older people, limiting opportunities for contact
persons shoes, on the other hand, permits an
between generations, thus creating barriers to living at home found that an empathic awareness
intergenerational understanding. In the context of of generational distinctiveness mediated
generational intelligence, elder abuse is therefore intergenerational social interaction. The students
seen as a form of damaged intergenerational and the older person receiving the service both
relations, due to ageism or dysfunctional gained, students- praise and self-esteem, the older
organisational environments. person- an opportunity for social engagement
whilst receiving support. From this study, a range
At a broader structural level, policy, legislation and
of findings regarding the use of generational
regulation play a role in reducing negative risk but
intelligence are relevant to the prevention of elder
also in permitting positive actions. For example
abuse within formal care arrangements. These
enacting the European Convention on Human Rights
included:
into domestic law will make little impact if there
is not a monitoring system in place. States need a. Learning how to be aware of generational
to actively address structural factors like ageism, differences and to accept them built empathy.
by promoting generational empathy, common In the study young people became aware of
understanding and resilience within society and in the need to accommodate the life situation of
this way focus on prevention of elder abuse rather the older person,
than risk avoidance which is not sustainable.
b. Being able to put ones self in anothers shoes
results in sustained and mutually rewarding
3.5 Generational Intelligence interaction. The study highlighted how the
in the context of caregiving young people recognised that social interaction
was what the older person really wanted
According to Haapala, Tervo & Biggs (2015) c. Active communication and opportunities
exploring the factors that contribute to sustainable for interaction in the delivery of services
forms of an intergenerational relationship is now contributed to a willingness to negotiate
an important conceptual and practical challenge, solutions. In the study the young people
not least because of the growing need for an aged recognised the need to let the older person
care workforce that is suitably trained (Haapala et feel in control of the situations.
al., 2015). Generational intelligence has therefore
been posited as means of examining and promoting e. Acting in a manner that is generationally
positive interaction between younger and older aware prioritises and values both generations
people in community care settings. It is suggested perspective. The study found that the priorities
that intergenerational relations have been a missing for both groups related to life course position,
factor in understanding sustainable care and the young people were concerned with their
that in future, service delivery should not simply future for example finding a job; the older
be analysed as comprising professional and lay people with the present for example concern
perspectives but also as containing generationally for their health and its impact on daily activities.
distinctive perspectives.
g. Developing ways of assessing potential care
Haapala et al. (2015) in a study of the employment workers and nurses levels of generational
of rural youth in service delivery for older people intelligence (low versus high) would help
to screen out those entirely unsuitable for of elder abuse and approaches to the protection of
the role and to provide better support and older people. It makes an invaluable contribution
preparation for those entering such positions to understandings of elder abuse and responses to
or those already in them but struggling. it. However, what is still needed is an alternative
that builds on the above by circumventing those
Krout and McKernan (2007) have argued that
traditional binary oppositions that continue to
there is an absence of comprehensive approaches
underpin the theories outlined in Chapter 2.
that prepare young people for work with older
Generational intelligence offers a more holistic and
adults and their own ageing. Haapala et al.s (2014)
nuanced approach to the intersection between
work, as described above, would suggest that the
societal systems and the lived experiences of
generational intelligence model can be used to help
elder abuse. It bridges this gap, tackling individual
prepare both parties for their interaction.
behaviours and prejudices as well as the broader
taken-for-granted social values that contribute to an
3.6 Conclusion environment where ageism and elder abuse occurs.
Putting theory into practice requires the use of an

In this chapter, generational intelligence as a appropriate medium which allows for the transfer
framework for creating an environment that of theory into practice. Sociodrama is an approach
supports positive interactions, both at the level of noted for addressing social issues. Chapter Four
the individual and societal, thus prevent abuse, is will explore the potential for using sociodrama
explored. Certainly, ODonnell et al.s (2015) use of underpinned by a generational intelligence
Bronfenbrenners (1979) theoretical framework to framework in developing interventions to prevent
help identify, categorise and evaluate interventions elder abuse.
takes into account the multiple interlinking levels
4
A Sociodrama Approach
Chapter
Augusto Boal, in his introduction to Theatre of the
4.1 Introduction Oppressed, asks the question should art educate,
inform, organise, influence, incite to action or
In Chapter Three, it was argued that generational should it simply be an object of pleasure? (1985:
intelligence provided a way of understanding elder xiiii). The former offers the possibility of addressing
abuse in terms of interpersonal relationships and at elder abuse by involving people in creative drama to
a societal level. The benefit of using this approach improve their quality of life and to combat ageism in
hinges mainly on how it treats intergenerational all its forms.
empathy as an imperative, focusing our attention on
the positive potential of being able to put ourselves Creative drama is an approach specifically
in the shoes of people of other ages in order to avoid developed for educational and awareness raising
negative intergenerational othering. It enables purposes. It is an improvisational, non-performance
positive interactions between age cohorts and can driven and process oriented form of drama. Learner-
significantly reduce causal factors associated with participants are guided by a facilitator to imagine,
elder abuse. The aim of this chapter is to demonstrate enact and reflect on experiences that may be real
the benefits of combining generational intelligence or hypothetical scenarios designed to raise specific
framework with creative and performing arts. issues in a space where thoughtful engagement with
Sociodrama is outlined here as a highly appropriate difficult subjects can occur.
and complimentary vehicle for opening up dialogue Creative drama is the preferred term for dramatic
around such a taboo topic in order to address the experiences that are designed for the development
individual, personal, familial, professional, systemic,
of cognitive, affective, aesthetic, and moral
social and cultural constituents of elder abuse. thinking of the participants. Methods of creative
More specifically, sociodrama will be explored as a drama which address social and cultural issues are
medium for facilitating professional and personal varied in their approach. Creative drama is holistic
reflection and for building intergenerational in nature and combines internal reflection and
empathy, especially within care settings, with the external representation. The common core of basic
aim of preventing elder abuse. activities is always improvised. The process leads
to an acceptance of self, an awareness of personal
resources, and an awareness of the internal and
4.2 The Performing Arts and external influences on living (Freeman, 2003).
Drama Approaches to Training For this reason creative drama has been used as
a means of addressing the mental, physical, and
4.2.1 Creative drama emotional development of varying cultures. In
It was the ancient Greeks who first coined the term practice, individuals and groups set out to resolve
drama. Its meaning today remains very similar to problems and seek solutions through the medium of
their use of the verbs to do or to act and from exploration and expression.
drama, theatre evolved.
Creative drama has grown in recent years and attention of the director is upon the individual and
become the keystone of the work of numerous his private problems which are allowed to unfold
charities, NGOs and theatre companies across before the group of learner-participants. Although
Europe. Programmes using this approach provide the group approach is used, psychodrama is
bespoke toolkits and advanced training, tailored learner-centred and is concerned with the personal
with care to individual situations in order to access development of a group of private individuals. By
the cultural traditions and understanding of a contrast, with sociodrama, the group is the subject.
projects audience to clearly and sensitively address Moreno explains that sociodrama is based on the
areas of conflict for communities or age groups assumption that the group formed by the audience
(Amollo, 2002). is already organised by the participants social and
cultural roles (Moreno, 1953: 87).
As outlined above, creative drama is an exploratory
tool used with other multi-disciplinary methods to In sociodrama the group corresponds to the
understand, promote and achieve social change. individual in psychodrama. Psychodrama deals
Creative drama, in its development, has expanded with personal problems and personal catharsis
to meet the needs and demands of our ever- (Koleva, 2012: 313). Sociodrama approaches social
changing demographic environment. Sociodrama problems in groups and aims to achieve a social
is now a well-developed and increasingly important catharsis (Moreno, 1953: 88). Sociodrama focuses
tool for increasing social awareness and bringing on spontaneity which operates in the present
about positive behavioural change. (Koleva, 2012: 313). The group and the individuals
within it are propelled toward an adequate response
4.2.2 Sociodrama to a new situation or a new response to an old
Sociodrama is based on the work of Dr Jacob situation (Moreno, 1993: 13). Hence sociodrama
Levy Moreno (1889-1974), who is also known for is a method by which a group of individuals select
his creation of psychodrama, a method of group and spontaneously enact a specific social situation
psychotherapy which focuses on the individual and common to their experience. Each participant
their inner thoughts to help achieve understanding assumes and dramatises a variety of roles, usually
and change. focusing on problems and conflicts arising in certain
interpersonal situations. It is a method for exploring
Maurine Eckloff in her article Using Sociodrama to the relationships within and between groups in
Improve Communication and Understanding (2006), societies, whether local, national or global. The
refers to Morenos understanding of sociodrama in practitioner learns to analyse such systems by
his book, Who shall survive? (1953): setting them out physically using objects or group
While psychodrama focuses on the internal members as representations, giving voice to these
interactions of one man, sociodrama focuses identified roles within the system or culture. Through
on individuals in the process of interaction. role exploration (role reversal, doubling, mirroring
Moreno defines sociodrama as a deep amongst other provocative tactics), the practitioner
action method dealing with group relations. helps the group to identify where new responses
(Moreno, 1953: 87) might be possible and to practice the necessary
skills to achieve the desired change. The emphasis
Moreno also states that in psychodrama the is always on understanding how individuals, teams
and organisations function (Appendix One provides 2015: 8). These issues are multifaceted, and every
examples). organisation and situation is different, therefore
sociodramas on any given topic are always
The methods used encompass a wide range
custom-designed based on the unique experience.
of techniques: action methods draw on role
Sociodramas can be used in a variety of ways to
theory, role training, sociometry and sociodrama.
explore and resolve a multitude of issues within
Sociodrama and action methods are profoundly
workplaces including conflict, management/
effective and are used worldwide in organisational
subordinate relationships and gender and race
and professional settings10. They may be used for
issues.
many purposes including to:
assist communication; Bradshaw-Tauvon (2001) reflected on the use of
negotiation; sociodrama for peace building within local, regional
and international conferences in the UK, Sweden
conflict management and team building;
and Israel. She wrote that these settings provide
action research and strategic planning;
a marvellous forum to bring together diverse
predict outcomes or rehearse implementation;
cultures to explore social issues. She also described
supervise managerial or training problems. how sociodrama can be used to nurture genuine
encounters between individuals and small groups
and to create ways to affect constructive change
4.3 Sociodrama as a vehicle in and between societies, cultures and countries
for change (Kellermann, 2007: 23).
In the book, Sociodrama: Whos in your shoes?,

Sociodrama is intrinsically connected with social Patricia Sternberg and Antonia Garcia (2000) outline
issues and social action (Sternberg and Garcia, a number of case studies. One examines the effect
2000: 190). Moreno used the approach as far back of sociodrama on a group of carers establishing
as 1921 to mobilise people. He proved its value in an AIDS care unit. Sternberg and Garcia highlight
various projects as exemplified in the Theatre of the difference between learning new behaviour
Spontaneity and his Impromptu theatre. Theatre and learning new roles. Changing the way you
of Spontaneity and improvisational acting out- acknowledge and express different emotions can
exercises were seen by Moreno as having positive radically alter their effect. Learning new behaviours
outcomes. Later his method was used with many within roles we already play can create new
other dramatic aesthetics in the treatment of people perspective.
with mental and physical disabilities. (Scheiffele,
For instance, a teacher who practices
2008). being more firm with his students regarding
deadlines for reports is not learning a new role
Private and public agencies are increasingly but learning new behaviours to play an old
interested in employing the arts to strengthen role with greater satisfaction. (Sternberg and
communities. Sociodrama provides an opportunity Garica, 2000: 200)
for the dramatic enactment of real life situations In Ireland, the Gaiety School of Acting developed and
or conflicts that often go unresolved (Ridderstrm, implemented two programmes using sociodrama
10
Sociodrama and Creative Action Network (SCAN) www.sociodrama.co.uk
to address social issues: BREATHE11 and IN THEIR
SHOES. The BREATHE programme is a professional
4.4 Types of sociodrama
response to rising suicide rates among younger practices
people. BREATHE focuses on changing attitudes There are three main types of sociodrama:
and improving links between teachers, parents and
Crisis;
teenagers.
Political;
It opens up the potential for communication on a
Diversity.
more personal level and breaks down feelings of
isolation within oneself, within a school setting and Peter Felix Kellerman describes crisis sociodrama as
increases a sense of integration within the broader dealing with collective trauma and group responsive
community. IN THEIR SHOES is an anti-bullying to catastrophic events of national significance,
drama-based programme which aims to foster an (2007: 64) such as riots, natural disasters and
understanding of how active learning strategies can wars. Whereas diversity sociodrama deals, with
improve the classroom atmosphere. conflicts based on stereotypes, prejudice, racism,
intolerance, stigmatisation or negative bias against
Numerous studies highlight the impact of
people because of their diversity (2007: 104).
involvement in the arts on individuals and
Political sociodrama is seen as being, closely
communities alike. Edward Fiske (1999) in
related to political theatre (Kellerman , 2007: 84).
Champions of Change: the impact of the arts on
A number of approaches are used including image
learning pointed to significant improvements in
theatre, forum theatre, rainbow of desire and Boals
learning ability drawn from his extensive study. It is
(1972, 1992), Theatre of the Oppressed.
universally acknowledged that classroom learning is
effective only for a proportion of students, by using Forum theatre is a form of interactive theatre
the arts as a learning tool, changing the learning developed by the late Brazilian theatre director,
environment can open the possibility of effective Augusto Boal, as part of his Theatre of the Oppressed.
learning to many more students. Furthermore, in The focus is on shared experiences that stimulates
the Princeton University study How the Arts impact debate, communication and understanding of
community, Joshua Guetzkow (2002) measures the different perspectives in word and motion12. Forum
cognitive and psychological impact of participation theatre empowers the audience to actively explore
in the arts on the individual and found it offers an different options for dealing with shared problems
increased sense of individual, self-esteem and a and motivates them to make positive changes in
sense of belonging or attachment to community their own lives (Taite, 2010). The audience is shown a
(Guetzkow, 2002: 3). He correlates his findings with short play in which a central character (protagonist)
the beneficial effects of the arts in the social and encounters an oppression or obstacle led by an
cultural context indicating an increased sense of oppressor (antagonist), which s/he is unable to
collective identity (2002: 3). overcome. This sociodrama approach therefore
has the potential to create an environment where
complex, multifaceted issues like elder abuse can
be addressed.
11 12
https://gaietyschool.com/outreach/post-primary-school/breathe/ www.tobe.ie
their lack of influence and independence, and
4.5 Tackling elder abuse and paternalistic communication styles among staff.
promoting change through Biggs et al (1995) point to how abuse in institutional
settings needs to be dealt with separately as it is
creative drama associated with certain characteristics. For instance,
4.5.1 Tackling elder abuse a these include differences in perception as to the role
multifaceted concept of the institution, for staff it is a workplace but for
Elder abuse is a complex, multifaceted concept. residents it is their home. However residents must
The discussion so far highlights what Biggs (2014) lead their private lives outside of their domestic
refers to as three different narratives or discourses environment, in a public setting. The institution,
elder abuse conceived as located within whilst a public place, can be cut off from the outside
interpersonal relationships, elder abuse as a result world. With the pressures of work, individual
of ageism at an organisational/societal level and and broader institutional structures dominate,
elder abuse due to the failure of the state to protect and where tasks or workload become more
the individuals human rights. In developing a important than residents rights and requirements,
programme to promote change, ways of opening up mistreatment is always waiting in the wings.
interconnecting pathways between these narratives (Biggs et al., 1995: 78).
are considered.
4.5.2 Applying sociodrama to training
At the interpersonal relationship level, adopting
As has been previously established, sociodrama
a generational intelligence approach by building
has the ability to be an intergenerational learning
empathy generates positive interactions,
strategy that combines a case study approach with
permitting individuals to get beyond their own
traditional role-play methodology to raise and
priorities and the social barriers surrounding age.
address a variety of issues to directly tackle elder
At the organisational level, aspects of the culture
abuse. Enhancing empathy and raising awareness
of an institution can lead to the failure to provide
of human rights will be one of the main objectives.
appropriate care to older people. These include
This unique customized approach to training can
ageist attitudes, loss of personal identity and the
also facilitate personal growth, raise consciousness,
positioning of the older person within the context of
and initiate attitudinal and behavioural changes in
factors that include status, rights and duties. Elder
the learner-participants. The benefits of applying
abuse addressed within the context of human rights
these dramatic techniques in educational and
is rarely recognised at the level of interpersonal
training settings are wide reaching. Not only can
relationships, but more as a macro level obligation.
they provide an action-oriented forum for resolving
Hence little work has been done on promoting such
conflicts among people with different views and life
rights at the micro level.
experiences, reflecting the concept of generational
Elder abuse and the protection of human rights intelligence, they are also effective in:
are of serious concern across the spectrum of care
clarifying personal and organisational values;
settings. This has been highlighted by Theurer et
al (2015) in a study of activities in residential care developing social skills;
settings, where residents report frustration around problem solving;
diagnosing organisational issues; kinaesthetic, emotional and cognitive educational
nurturing understanding; methodology (Hawkins, 2014). The concepts
underpinning intervention workshops can address
enhancing empathy;
elder abuse prevention on a number of levels
developing and rehearsing action plans; empowerment through education, activation of
improving personal effectiveness and human rights through awareness and by building
awareness. empathy to challenge ageism can aid the broader
development of elder abuse policy.
The sociodrama system is particularly suited to
elder abuse prevention as it incorporates these four
components
4.6 Conclusion
1. It is based on the realities and issues being Throughout this chapter we have investigated
actively experienced by the participants or the potential of sociodrama underpinned by a
organisation.
generational intelligence framework as an effective
2. The investigation proceeds through vehicle for development and delivery of elder
improvisational theatre allowing workshop
abuse prevention and intervention strategies.
participants to explore the issues and
share through their own experiences, thus, Generational intelligences strives to enable others
encouraging group empowerment and walk in an older persons shoes. Sociodrama
ownership over the workshop. In sociodramas, supports the learning of new behaviours within
participants take on the role of another.
This allows them to develop an empathic roles we already play, by reflecting on why we
understanding of that persons point of view act in a certain way. The proposed model has the
or feelings, allowing them the opportunity to potential to revolutionise current approaches to
walk in anothers shoes.
elder abuse prevention models by challenging
3. Within the scene work a dialogue is opened ageist stereotyping, enhancing relationships and
up between the characters and the audience increasing understanding between caregivers and
(other participants), allowing interpersonal
relationships to develop and other perspectives care recipients.
to be explored in which numerous alternative
communication strategies can be discovered.
Discussion should assist participants and
audience to realise motivations, purposes,
behaviour, implications and possibilities for the
prevention of problem situations.
4. Through the intentionally designed experiential

workshops the educational, behavioural and
psychological objectives can be promoted,
encouraging the participants to reflect on how
to achieve the implementation of the goals
identified within their own organisation.
Creative drama is a group interaction process used

to assist all types of people in meeting specified
goals. The method draws upon a persons ability
to learn with their whole body and mind It is a
5
Conclusions
Chapter
The consistent quality and quantity of data collected
5.1 Introduction in each country remains a barrier to estimating the
prevalence of elder abuse. Nevertheless, it is safe
The world is ageing rapidly as evident in the four to say that older people with significant physical
countries discussed. By 2050, 32.4 per cent of the and cognitive impairment who are dependent on
population in Finland will be 60 and over, 40.7 per others for care were identified as being particularly
cent in Italy, 31 per cent in Ireland and 36.4 per cent in vulnerable to elder abuse.
Romania (UN, 2015). With the subsequent increase
in the more vulnerable older old, elder abuse has the Research, where available, points to adult children as
potential to impact on the lives of a growing number the main perpetrators of abuse, with abuse occurring
of people. Although awareness of elder abuse is mainly in the older persons home. In many situations,
growing, understandings of the problem have not the older person may not recognise the behaviour as
advanced significantly since studies describing elder abusive, or even where they do, the perpetrator is
abuse first appeared in scientific journals in the often their son or daughter, who they still love. Data
1970s. on prevalence rates for abuse within residential care
settings is limited. However, according to Finnish
Understandings of elder abuse are important as research, abuse may be an every-day phenomenon,
they determine how elder abuse is defined and but invisible due to fear of repercussions (Uuttu-Riski,
responded to within countries. Reviewing the 2004; Laakso, 2015). Hence, elder abuse remains a
definitions and typologies of elder abuse adopted taboo subject and is not addressed at a societal level.
within the four countries in Chapter 1, it was evident Under-reporting of abuse by older people is therefore
that whilst there were similarities in how elder an issue in all countries. Increased education of all
abuse is understood, there were also differences. age groups around the issues is certainly required.
Ireland is the only country from amongst the four
to have in place a national elder abuse policy. Elder
abuse is understood within a health and social 5.2 Addressing elder abuse
care framework. Within this policy, elder abuse
encompasses both interpersonal typologies of abuse:
To determine the best ways of addressing elder
physical, sexual, emotional and financial abuse, but
abuse, there is a need to ascertain causal factors.
also wider structural forms including discriminatory
In Chapter 2, a number of theories were proposed.
and institutional abuse. In Italy, the abuse most
These theories mainly come from other fields such
widely recognised is financial abuse and this is
as child protection and intimate partner violence.
addressed through the penal system. Financial abuse
The theories relate to interpersonal relationships
is understood however in the wider context of crimes
such as caregiver stress theory and those focused at
targeted at older people. In Romania, legislation is in
a societal level such as feminist notions of unequal
place to address physical abuse, so this form of abuse
power relations. Factors that place the older person
is more widely recognised.
at risk emerge from these different theories.
Research evidence from all four countries identified Ireland has developed and implemented a national
similar risk factors for abuse. Poor health, older age, elder abuse policy, the other three countries do not
female gender, low income, cognitive impairment have such policies.
and limited social network, all contributing to the
It is evident from the above discussion, that
persons vulnerability. With older age, there is more
understandings of elder abuse shape how states
likely to be a decline in health, physical and cognitive,
respond to the issue of elder abuse. In countries like
resulting in the older person being dependent on
Italy and Romania, elder abuse remains very much
others for care and support. The caregiver stress
an issue between individuals, to be solved through
model therefore has long been the predominant
the criminal system. Although, elder abuse is
model used to explain occurrences of elder abuse.
recognised as a public issue in Ireland, it is addressed
Studies undertaken in the four countries highlighted
within the health and social care system, hence not
a number of factors associated with caregiving that
attending to wider societal factors such as ageism. It
can lead to a failure to provide appropriate care
is therefore argued that to understand elder abuse,
including carer burnout, ageist attitudes, a task
there is a need to move beyond the theories outlined
centred working culture, insufficient training and
and away from the notion of binary oppositions -
education.
victim and perpetrator, individual relationships
Interventions to address elder abuse at the versus societal and cultural structures, to one that
interpersonal relationship level therefore mainly acknowledges the complexities of elder abuse and
centre on promoting resilience of carers and the inextricable links between micro-interaction
supporting the empowerment of the older person. (interpersonal relationships), institutional
For example in Italy, psycho-educational courses (organisational characteristics) and macro-element
addressing carer stress are available to formal (e.g. ageism). Generational intelligence is posited
and informal carers; in Ireland, the Keep Control as a theoretical basis for understanding elder
programme focuses on empowering older people abuse that addresses the complexities related to
to stay in charge of their finances. interpersonal relationships and the wider social
environment.
At a societal level, the lack of clear policies, and/
or their implementation, regarding elder abuse
puts older people at risk (Uuttu-Riski, 2002). From
a feminist theory perspective, the fact that women
5.3 Addressing elder abuse
are more at risk of elder abuse could be linked through a generational
to their lower status in society, and hence less
attention to their priority. From a positioning theory
intelligence framework
point of view, society assigns a lower position, even
malignant to dependent older people, so they Generational intelligence acknowledges within
are not viewed as having the same rights as the any society, generational identities exist between
rest of society. Interventions at a societal level are socially and self defined age groups and as a
less apparent in the four countries. None of the consequences similarities and differences as well as
countries have legislated to promote and protect conflict and solidarity can develop between groups.
the rights and dignity of older people and whilst At a societal level, there is an assumption that all
generations share the same priorities, however this
is not the case. The priorities of the more dominant the challenges of interaction across age groups and
generation usually take precedent. For example in point to the absence of comprehensive approaches
public debates, there is little attention paid to older that prepare young people for working with older
peoples issues, except where older people are adults.
seen to impact on public services important for the
To understand and interact in an empathetic way
dominant generation, such as the health service.
requires experiential opportunities. Sociodrama is
Ageism, the stereotyping and discrimination of
a medium that can facilitate the learning of new
people because they are old, results in less value
behaviours by modifying ones own behaviour
being placed on older peoples priorities and their
within ones old role creating a new perspective.
rights, creating a social space where abuse can
Sociodrama also facilitates taboo subjects like elder
happen.
abuse to be spoken about and unresolved conflicts
Viewing elder abuse through a generational to be addressed.
intelligence lens requires the individual and society
Using a generational intelligence approach as the
to reflect on ones own generational identity, be
theoretical foundation to underpin elder abuse
aware of generational differences, and act on this
prevention education programmes, integrated
awareness by being able to walk in the other persons
within a sociodrama approach, has the potential
shoes. Understand that there are power differentials
to revolutionise current approaches to elder abuse
between generations and this influences value
prevention. It can provide a new perspective
positions, so there is a need for compromise and the
and understanding through which staff and
consideration of multiple perspectives. A high level
organisations view their roles, advancing residents
of generational intelligence allows for empathetic
social identity, enhancing reciprocal relationships
interaction between generations leading towards
and challenge ageist assumptions. It will allow for
greater intergenerational understanding bridging
more self-awareness, self-care, and satisfaction on
the generational gap that can give rise to ageism
a personal and professional level. It is envisaged
and abuse.
that the model will lay the groundwork for further
The focus of interventions to address elder abuse research and educational training models.
using a generational intelligence framework is
therefore on building empathy between generations.
This is particularly relevant for older people receiving
formal care, be it in a residential or day care settings,
as the aged care workforce is predominantly made
up of younger people, many even coming from a
different culture. Haapala et al (2015) contend that
a generational intelligence framework can mediate
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APPENDIX
APPENDIX ONE
Examples of creative drama projects
NAME WEBSITE SHORT DESCRIPTION

Forum theatre/sociodrama workshops promoting
http://www.smashingtimes.ie/page-2/4- positive mental health and raising awareness on suicide
acting for the Future acting-for-the-future/ prevention within secondary schools, and community
based youth/adult groups
An innovative arts programme using drama and theatre
http://www.smashingtimes.ie/page-2/page- to promote reconciliation and mutual understanding
acting for peace 2b/ within the Southern Border Counties of the Rep. of
Ireland and Northern Ireland
http://ageandopportunity.ie/what-we-do/
aging with aonfidence education-training/ageing-with-confidence
Positive mental health training for the elderly.
http://ageandopportunity.ie/what-we-do/ Awareness of attitudes to aging training for health care

age wise education-training/agewise professionals
A schools programme of intergenerational learning,
seeking to promote and cultivate the enriching
living scenes http://nuigalway.ie/living_scenes/
relationship between older and younger adults using
creative drama and other arts techniques.
http://www.kkh.se/research/artistic-
development-projects/the-resonant-body- Psychodrama and Sociodrama as an Experimental
resonant body psychodrama-and-sociodrama-as-an- Artistic Strategy with the elderly.
experimental-artistic-strategy/
forum theatre in elder Strong Network 2006-2010. Forum theatre

workshops, exploring methods and procedures for
abuse prevention and http://www.suvantory.fi/hankkeet/
elder abuse prevention with social and health care
awareness raising professionals.
transcript of
dal teatro della https://prezi.com/_gxl7ly3z0ay/dal-teatro- The project uses sociodrama to tackle social issues
spontaneit al della-spontaneita-al-sociodramma/ among teenagers
sociodrama
http://www.playback.it/
Acting company La Compagnia del Fare e del Disfare
http://www.playback.it/faredisfare/
playback uses playback technique to tackle issues around the
http://www.psicosociodramma.it/ older person, their families and their caregiver histories
ChiHaUnAltraStoria.html
depends on you. A theater workshop has been delivered with pupils
http://transcena.ro/proiecte/#toggle-id-1 a show about bullying was elaborated, a scenario
summer school theater constructed based on the ideas and proposals of
workshop http://transcena.ro/proiecte/#toggle-id-4
participating pupils
EUBULLY offers a blended approach creating

innovation in the virtual world alongside transfer
EUBULLY http://bully4u.ie/eu-bully-2/ and roll out of best practice in the use of drama in
the physical world, both providing safe and secure
environments for bullying to be addressed openly.
The project aims to use local artists to promote diversity

http://www.enpi-info.eu/medportal/ through theatre across the region, engaging all levels of
news/latest/37956/Drama,-Diversity-and-
drama , diversity and Development---street-theatre-to-challenge-
society, including post-performance debates between
development discrimination:-call-for-proposals-under- actors and members of the public to trigger dialogue
MedCulture-regional-programme about multiplicity, difference, discrimination, equality
and justice
The project works to change behavior and attitude of
young people and adults with an artistic vocation. It
http://instal.utcb.ro/site/eng/sigma_
SIGMA ART presentation.pdf
promotes development within an artistic and social
field, helping them to integrate encouraging cultural
exchange through art.
Tender works with young people in an effort to prevent
tender http://tender.org.uk/
and address the issue of unhealthy relationships.
The theatre project Shame was founded in 2012 and
the idea was that people in rehabilitation for mental
health problems, professional actors and a theatre
shame http://www.kokoteatteri.fi/ohjelmisto/peili/
would collaborate in making a theatre production. The
play is about humanity, the right to live, to be heard
and to be visible.
The project is based on a performing arts diploma
consisting of theatre originated methods used in social
elmst pudonnut work. The target groups of the project are older people
kuva (picture dropped http://www.taiteensulattamo.fi/ and young people in contact with the criminal justice
out of life) project system. The project consists of workshops as well an
experiential exhibition presenting the results of the
workshops.
The Project is run by four cultural and nine third sector
tee itse taidetta ja social and health care organisations. The target groups
osallistu TEIJO Make http://www.pudonnutkuva.fi/opinnayte
include children and young people in child protection,
your own art and adults with special needs as well as seniors living in
participate project nursing homes. The project aims to bring art to these
peoples lives. of human life
The project applies exercises developed by the theatre,

Telakka. The exercises are intended to find ways in
subproject http://www.telakka.eu/teatteri/?page_ which people with disabilities can strengthen their life
teatterista voimaa id=4027 and coping skills. The aim is to highlight their creative
vuorovaikutukseen personal solutions and utilise them in the context of a
- Effectivity for problem. This facilitates human self-expression, which
interaction from http://www.telakka.eu/teatteri/?page_ in turn strengthens self-esteem. Good self-esteem
theatre id=4024 enables people with disabilities to be a visible part of
the surrounding society. The projects aim is to bring
people together.

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ELDER ABUSE CONTEXT AND THEORY

Finland, Ireland, Italy and Romania

The S.T.AGE project is funded by Erasmus+

The S.T.AGE project is funded by Erasmus+

Chapter 2: Theoretical Perspective

3.3 Generational Intelligence and elder abuse p. 33

3.4 Ageism and elder abuse p. 33

3.5 Generational Intelligence in the context of caregiving p. 34

Chapter 4: Sociodrama Approach

4.3 Sociodrama as a vehicle for change p. 38

4.4 Types of Sociodrama Practices p. 39

4.5 Tackling elder abuse and promoting change through Creative p. 40

5.2 Addressing elder abuse p. 42

5.3 Addressing elder abuse through a generation intelligence p. 43

Sam OBrien-Olinger, Age Action (Ireland)

Licia Boccaletti, Anziani e non solo (Italy)

Salvatore Milianta, Anziani e non solo (Italy)

Ioana Caciula, Asociatia HABILITAS Centru de Resurse si Formare Profesionala (Romania)

Henriikka Laurola, Suvanto For a Safe Old Age (Finland)

Sirkka Perttu, Suvanto For a Safe Old Age (Finland)

Anna Kadzik-Bartoszewska, The Gaiety School of Acting (Ireland)

Kate Canning, The Gaiety School of Acting (Ireland)

Seamus Quinn, The Gaiety School of Acting (Ireland)

and over in the state, accounting for 11.7 per cent

2.1 Theories that inform Social Learning Theory

2.1.2 Theories related to societal and a Social Ecology Theory

Whilst theories inform understanding, OLoughlin low income, poor health;

IRELAND, FINLAND, ITALY

COUNTRY WHERE FOUND RELEVANT

least restrictive alternative;

protection of the law;

access to judicial process.

It is evident from the previous chapter that theoretical

Putting theory into practice requires the use of an

In the book, Sociodrama: Whos in your shoes?,

4. Through the intentionally designed experiential

Creative drama is a group interaction process used

Boal, A., (1995) The Rainbow of Desire: the boal

Koleva, M. (2012) Psychodrama and sociometric Mki-Petj-Leinonen, A.,(2003). Dementoituvan

Virjo, I. & Kivel, S-L., (1994). vergrepp mot ldre

Wango T., Teaster P.B., Grace J., Wong W., Mendiondo

Whittaker, T., (1995). Violence, gender and elder

WHO/INPEA, (2002). Missing voices: views of older

Working Group on Elder Abuse (2002) Protecting our

NAME WEBSITE SHORT DESCRIPTION

http://ageandopportunity.ie/what-we-do/ Awareness of attitudes to aging training for health care

forum theatre in elder Strong Network 2006-2010. Forum theatre

EUBULLY offers a blended approach creating

The project aims to use local artists to promote diversity

The project applies exercises developed by the theatre,

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